Provider Demographics
NPI:1184491359
Name:LONE TREE RETIREMENT COMMUNITY LLC
Entity type:Organization
Organization Name:LONE TREE RETIREMENT COMMUNITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-500-7930
Mailing Address - Street 1:10300 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3135
Mailing Address - Country:US
Mailing Address - Phone:316-448-0850
Mailing Address - Fax:
Practice Address - Street 1:801 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MEADE
Practice Address - State:KS
Practice Address - Zip Code:67864-9557
Practice Address - Country:US
Practice Address - Phone:620-873-2146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility