Provider Demographics
NPI:1891235701
Name:SEQUEL YOUTH SERVICES OF FALCON RIDGE
Entity Type:Organization
Organization Name:SEQUEL YOUTH SERVICES OF FALCON RIDGE
Other - Org Name:FALCON RIDGE RANCH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MHC, CMHC
Authorized Official - Phone:435-635-5260
Mailing Address - Street 1:PO BOX 790099
Mailing Address - Street 2:
Mailing Address - City:VIRGIN
Mailing Address - State:UT
Mailing Address - Zip Code:84779-0099
Mailing Address - Country:US
Mailing Address - Phone:435-635-5260
Mailing Address - Fax:435-635-5327
Practice Address - Street 1:747 E SAINT GEORGE BLVD
Practice Address - Street 2:FALCON RIDGE RANCH
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3035
Practice Address - Country:US
Practice Address - Phone:435-635-5260
Practice Address - Fax:435-635-5327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE YOUTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84001266004323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility