Provider Demographics
NPI:1417073339
Name:SEQUOIA RECOVERY SERVICES
Entity Type:Organization
Organization Name:SEQUOIA RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:I
Authorized Official - Credentials:CAC II
Authorized Official - Phone:248-745-6940
Mailing Address - Street 1:363 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1423
Mailing Address - Country:US
Mailing Address - Phone:248-745-6940
Mailing Address - Fax:248-745-6922
Practice Address - Street 1:363 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1423
Practice Address - Country:US
Practice Address - Phone:248-745-6940
Practice Address - Fax:248-745-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630950324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1705289Medicaid