NPI 1073843868

Sequel Tsi of Idaho, LLC

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Mountain Home, ID

Practice location

Address: 2850 Industrial Way, Mountain Home, ID 83647-3960
Phone: (208) 587-2679
Fax: (208) 587-2875

Authorised official

Name: John Stupak
Title: President
Phone: (267) 419-8913

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

Other Residential Treatment Facility, Emotionally Disturbed Children providers in Idaho →

Registry record

NPI: 1073843868
Entity type: Organization
NPI issued: 30 Dec 2009
Record last updated: 30 Dec 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.