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General NPI Number Information
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NPI Number | 1174598395
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Entity Type | Organization
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Legal Business Name | LEMONTREE ENTERPRISES, LLC DBA LIBERTY JUVENILE SERVICES & TREATMENT
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2050 W 11TH STREET N
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City | WICHITA
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State | KS
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Zip | 67203
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Country | US
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Telephone | 316-267-5710
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 W 11TH ST N
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City | WICHITA
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State | KS
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Zip | 67203-3006
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Country | US
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Telephone | 316-267-5710
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. TIMOTHY SMITH
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Credential |
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Telephone | 316-267-5710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 440861
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License Number State | KS
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