Provider Demographics
NPI:1790196376
Name:SEQUEL OF NEW JERSEY, INC.
Entity Type:Organization
Organization Name:SEQUEL OF NEW JERSEY, INC.
Other - Org Name:CAPITAL ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:R
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-880-3339
Mailing Address - Street 1:1024-1026 COLLINGS AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1811
Mailing Address - Country:US
Mailing Address - Phone:856-240-7355
Mailing Address - Fax:856-635-0292
Practice Address - Street 1:1024-1026 COLLINGS AVENUE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08107-1811
Practice Address - Country:US
Practice Address - Phone:856-240-7355
Practice Address - Fax:856-635-0292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUEL YOUTH AND FAMILY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility