Provider Demographics
NPI:1174598395
Name:LEMONTREE ENTERPRISES, LLC DBA LIBERTY JUVENILE SERVICES & TREATMENT
Entity type:Organization
Organization Name:LEMONTREE ENTERPRISES, LLC DBA LIBERTY JUVENILE SERVICES & TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-267-5710
Mailing Address - Street 1:2050 W 11TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3006
Mailing Address - Country:US
Mailing Address - Phone:316-267-5710
Mailing Address - Fax:
Practice Address - Street 1:2050 W 11TH STREET N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203
Practice Address - Country:US
Practice Address - Phone:316-267-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS440861323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000352OtherBCBS OF KS
KS0000105048OtherBCBS OF KANSAS