Organization
LEMONTREE ENTERPRISES, LLC DBA LIBERTY JUVENILE SERVICES & TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY SMITH (CHIEF FINANCIAL OFFICER)
(316) 267-5710
Entity
Organization
Contact information
Practice address
2050 W 11TH STREET N, WICHITA, KS 67203
(316) 267-5710
Mailing address
2050 W 11TH ST N, WICHITA, KS 67203-3006
(316) 267-5710
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
440861
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000105048
BCBS OF KANSAS
KS
01
—
000352
BCBS OF KS
KS
Enumeration date
02/21/2006
Last updated
08/22/2020
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