Provider Demographics
NPI:1033704754
Name:THE SHADE TREE LLC
Entity Type:Organization
Organization Name:THE SHADE TREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAHLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:636-358-1889
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:ARROW ROCK
Mailing Address - State:MO
Mailing Address - Zip Code:65320-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 S HIGHLAND CT
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3058
Practice Address - Country:US
Practice Address - Phone:636-358-1889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility