Provider Demographics
NPI:1568793362
Name:SEQUEL TSI OF ALABAMA, LLC NEW DIRECTIONS
Entity Type:Organization
Organization Name:SEQUEL TSI OF ALABAMA, LLC NEW DIRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STUPAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-419-8913
Mailing Address - Street 1:318A HAMER RD
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9612
Mailing Address - Country:US
Mailing Address - Phone:256-725-7170
Mailing Address - Fax:256-725-7169
Practice Address - Street 1:318A HAMER RD
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9612
Practice Address - Country:US
Practice Address - Phone:256-725-7170
Practice Address - Fax:256-725-7169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUEL TSI OF ALABAMA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children