Provider Demographics
NPI:1881921898
Name:SEQUOYAH RESIDENTIAL MENTAL HEALTH FACILITY, INC
Entity type:Organization
Organization Name:SEQUOYAH RESIDENTIAL MENTAL HEALTH FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-775-7751
Mailing Address - Street 1:103 N WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4617
Mailing Address - Country:US
Mailing Address - Phone:918-775-7751
Mailing Address - Fax:918-775-7932
Practice Address - Street 1:103 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4617
Practice Address - Country:US
Practice Address - Phone:918-775-7751
Practice Address - Fax:918-775-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRC6801-6801320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness