Provider Demographics
NPI:1366832206
Name:SEQUEL YOUTH SERVICES OF ALBION, LLC
Entity Type:Organization
Organization Name:SEQUEL YOUTH SERVICES OF ALBION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-629-5591
Mailing Address - Street 1:13725 26 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-9525
Mailing Address - Country:US
Mailing Address - Phone:517-629-5591
Mailing Address - Fax:
Practice Address - Street 1:13725 26 MILE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-9525
Practice Address - Country:US
Practice Address - Phone:517-629-5591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency