Provider Demographics
NPI:1851422372
Name:SEQUELCARE OF FLORIDA LLC
Entity Type:Organization
Organization Name:SEQUELCARE OF FLORIDA LLC
Other - Org Name:BRIGHTER HEIGHTS FLORIDA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-712-4393
Mailing Address - Street 1:3491 GANDY BLVD N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2658
Mailing Address - Country:US
Mailing Address - Phone:727-547-0607
Mailing Address - Fax:727-547-6752
Practice Address - Street 1:3491 GANDY BLVD N
Practice Address - Street 2:SUITE 201
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2658
Practice Address - Country:US
Practice Address - Phone:727-547-0607
Practice Address - Fax:727-547-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100001014251B00000X, 251S00000X, 251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281413OtherAMERIGROUP OF FLORIDA
FL550560OtherVALUE OPTIONS
FLHCC10073OtherCLINIC LICENSE
FL076079000Medicaid
FL793876000OtherMAGELLAN BEHAVORIAL HEALT
FL913829300Medicaid
FL075937600Medicaid
FL076699200Medicaid
FL33781OtherUNITED BEHAVIORAL HEALTH