Organization
FREEDOM GATES BOYS RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY FREITAG (CHIEF FISCAL OFFICER)
(620) 239-4031
Entity
Organization
Contact information
Practice address
304 N CHURCH ST, HAZELTON, KS 67061-9300
(620) 239-4031
(620) 239-4032
Mailing address
PO BOX 103, KIOWA, KS 67070-0103
(620) 239-4031
(620) 239-4032
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548479223
—
OK
Enumeration date
08/10/2022
Last updated
08/10/2022
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