Provider Demographics
NPI:1821210501
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:CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GURULE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-710-9210
Mailing Address - Street 1:1131 EAGLETREE LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6491
Mailing Address - Country:US
Mailing Address - Phone:256-880-3339
Mailing Address - Fax:
Practice Address - Street 1:1770 MOUNT EPHRAIM AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-1837
Practice Address - Country:US
Practice Address - Phone:609-434-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYFS HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0124346Medicaid