Provider Demographics
NPI:1982150256
Name:SEQUEL YOUTH SERVICES OF FALCON RIDGE RANCH
Entity Type:Organization
Organization Name:SEQUEL YOUTH SERVICES OF FALCON RIDGE RANCH
Other - Org Name:FALCON RIDGE RANCH
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:256-880-3339
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:256-880-7026
Practice Address - Street 1:633 EAST HIGHWAY
Practice Address - Street 2:
Practice Address - City:VIRGIN
Practice Address - State:UT
Practice Address - Zip Code:84779
Practice Address - Country:US
Practice Address - Phone:435-635-5260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE YOUTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-28
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness