NPIMap

Organization Active NPI

Sequel Tsi of Idaho, LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Mountain Home, ID
National Provider Identifier
1073843868
Registry record updated Dec 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
SEQUEL TSI OF IDAHO, LLC
Practice address
2850 Industrial Way
Mountain Home, ID 83647-3960
Phone
(208) 587-2679
Fax
(208) 587-2875
NPI assigned
Dec 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John Stupak
Title
President
Phone
(267) 419-8913

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

2850 Industrial Way
Mountain Home, ID 83647-3960

Mailing address

2850 Industrial Way
Mountain Home, ID 83647-3960
Phone (208) 587-2679

Other names 1

  • Mountain Home RTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mountain Home4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2850 Industrial Way
Mountain Home, ID 83647
Phone (208) 587-2679

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262131200000",
    "number": "1073843868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 INDUSTRIAL WAY",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836473960",
            "telephone_number": "208-587-2679",
            "fax_number": "208-587-2875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 INDUSTRIAL WAY",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836473960",
            "telephone_number": "208-587-2679",
            "fax_number": "208-587-2875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUEL TSI OF IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-30",
        "last_updated": "2009-12-30",
        "status": "A",
        "authorized_official_last_name": "STUPAK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "267-419-8913",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Home RTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.