Provider Demographics
NPI:1548842354
Name:THE BAOBAB TREE LLC
Entity type:Organization
Organization Name:THE BAOBAB TREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARTEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:816-791-7239
Mailing Address - Street 1:5824 E 40TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64129-1714
Mailing Address - Country:US
Mailing Address - Phone:816-895-2742
Mailing Address - Fax:816-791-7165
Practice Address - Street 1:4707 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1735
Practice Address - Country:US
Practice Address - Phone:816-791-7239
Practice Address - Fax:816-791-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health