Sequel Tsi of Idaho, LLC
NPI #1073843868 in Mountain Home, Idaho
Provider Information
- NPI Number
- 1073843868
- Entity Type
- Organization
- Organization Name
- Sequel Tsi of Idaho, LLC
- Primary Specialty
- Residential Treatment Facility, Emotionally Disturbed Children
- Enumeration Date
- Dec 30, 2009
- Last Updated
- Dec 30, 2009
Practice Location
- Address
- 2850 INDUSTRIAL WAY
- City
- Mountain Home
- State
- Idaho
- ZIP Code
- 83647-3960
- Phone
- (208) 587-2679
Authorized Official
- Name
- MR. JOHN STUPAK
- Title
- PRESIDENT
- Phone
- (267) 419-8913
Specialties & Taxonomy Codes
| Specialty |
|---|
| Residential Treatment Facility, Emotionally Disturbed Children |
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