Provider Demographics
NPI:1245398908
Name:SEQUEL SCHOOLS LLC DBA KINGSTON ACADEMY
Entity Type:Organization
Organization Name:SEQUEL SCHOOLS LLC DBA KINGSTON ACADEMY
Other - Org Name:CAMELOT OF TENNESSEE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HEMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:865-376-2296
Mailing Address - Street 1:1131 EAGLETREE LANE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6478
Mailing Address - Country:US
Mailing Address - Phone:256-880-3339
Mailing Address - Fax:256-880-7026
Practice Address - Street 1:183 FIDDLER'S LANE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-4020
Practice Address - Country:US
Practice Address - Phone:865-376-2296
Practice Address - Fax:865-376-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL 2(37)M3-016-1155323P00000X
TNL000000008435323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1440370Medicaid
WV3810000021Medicaid