NPIMap

Organization Active NPI

Sequel Tsi of Florida, LLC

Doing business as Palm Beach Youth Academy

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • West Palm Beach, FL
National Provider Identifier
1699222026
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
SEQUEL TSI OF FLORIDA, LLC
Doing business as
Palm Beach Youth Academy
Practice address
9680 Fairground Rd
West Palm Beach, FL 33411-3528
Phone
(561) 333-0664
NPI assigned
Sep 1, 2016
Last updated
Sep 1, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
SEQUEL TSI HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Authorized official

Name
Mr. Kenny Roberts
Title
SVP Operations
Phone
(256) 880-3339

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary
Children's Substance Abuse Rehabilitation Facility 3245S0500X

Addresses

Primary practice location

9680 Fairground Rd
West Palm Beach, FL 33411-3528

Mailing address

9680 Fairground Rd
West Palm Beach, FL 33411-3528
Phone (561) 333-0664

Other names 1

  • Palm Beach Youth Academy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sequel Tsi of Florida LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

9680 Fairground Rd
West Palm Beach, FL 33411
Phone (561) 333-0664

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1699222026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9680 FAIRGROUND RD",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334113528",
            "telephone_number": "561-333-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9680 FAIRGROUND RD",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334113528",
            "telephone_number": "561-333-0664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUEL TSI OF FLORIDA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEQUEL TSI HOLDINGS, LLC",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SVP OPERATIONS",
        "authorized_official_telephone_number": "256-880-3339",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Beach Youth Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.