Provider Demographics
NPI:1457189698
Name:LEMON TREE REHABILITATIVE SERVICES LLC
Entity type:Organization
Organization Name:LEMON TREE REHABILITATIVE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESILET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-704-5565
Mailing Address - Street 1:200 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-9278
Mailing Address - Country:US
Mailing Address - Phone:904-704-5565
Mailing Address - Fax:
Practice Address - Street 1:850 INDIGO ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3763
Practice Address - Country:US
Practice Address - Phone:904-704-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty