Healthcare Provider Details

I. General information

NPI: 1013137397
Provider Name (Legal Business Name): LEMON TREE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 W 11TH ST N
WICHITA KS
67203
US

IV. Provider business mailing address

2050 W 11TH ST N
WICHITA KS
67203
US

V. Phone/Fax

Practice location:
  • Phone: 316-267-5710
  • Fax: 316-267-7510
Mailing address:
  • Phone: 316-267-5710
  • Fax: 316-267-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number44086-1
License Number StateKS

VIII. Authorized Official

Name: TIMOTHY SMITH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 316-267-5710