Provider Demographics
NPI:1699222026
Name:SEQUEL TSI OF FLORIDA, LLC
Entity Type:Organization
Organization Name:SEQUEL TSI OF FLORIDA, LLC
Other - Org Name:PALM BEACH YOUTH ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-880-3339
Mailing Address - Street 1:9680 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3528
Mailing Address - Country:US
Mailing Address - Phone:561-333-0664
Mailing Address - Fax:
Practice Address - Street 1:9680 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3528
Practice Address - Country:US
Practice Address - Phone:561-333-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUEL TSI HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children