Healthcare Provider Details

I. General information

NPI: 1396711818
Provider Name (Legal Business Name): LAKEMARY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKEMARY DR
PAOLA KS
66071-1855
US

IV. Provider business mailing address

100 LAKEMARY DR
PAOLA KS
66071-1855
US

V. Phone/Fax

Practice location:
  • Phone: 913-557-4000
  • Fax: 913-557-4910
Mailing address:
  • Phone: 913-557-4000
  • Fax: 913-557-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN KELSEY
Title or Position: DIRECTOR OF FISCAL SERVICES
Credential:
Phone: 913-557-4000