Provider Demographics
NPI:1962855452
Name:SEQUEL POMEGRANATE HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:SEQUEL POMEGRANATE HEALTH SYSTEMS, LLC
Other - Org Name:POMEGRANATE HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PROGRAM OFFICER/EVP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-278-2103
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 1:765 PIERCE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2425
Practice Address - Country:US
Practice Address - Phone:614-223-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUEL ACADEMY HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital