Provider Demographics
NPI:1215218987
Name:THE LEMONADE STAND
Entity Type:Organization
Organization Name:THE LEMONADE STAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEALY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:414-763-1868
Mailing Address - Street 1:PO BOX 18422
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-0422
Mailing Address - Country:US
Mailing Address - Phone:414-763-1868
Mailing Address - Fax:414-763-5155
Practice Address - Street 1:5507 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1548
Practice Address - Country:US
Practice Address - Phone:414-763-1868
Practice Address - Fax:414-763-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health