NPIMap

Organization Active NPI

Sequel Tsi of Idaho, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Mountain Home, ID
National Provider Identifier
1891047296
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
SEQUEL TSI OF IDAHO, LLC
Practice address
2850 Industrial Way
Mountain Home, ID 83647-3960
Phone
(208) 587-2679
NPI assigned
Oct 9, 2012
Organization subpart
Yes
Parent organization
SEQUEL TSI HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Authorized official

Name
Mr. Chris Banken
Title
Sr. Vice Prsident of Operations
Phone
(602) 335-2095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

2850 Industrial Way
Mountain Home, ID 83647-3960

Mailing address

2850 Industrial Way
Mountain Home, ID 83647-3960

Other names 1

  • Mountain Home 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.

NPI Registry JSON

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

{
    "created_epoch": "1349740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1891047296",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUEL TSI OF IDAHO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEQUEL TSI HOLDINGS, LLC",
        "enumeration_date": "2012-10-09",
        "last_updated": "2012-10-09",
        "status": "A",
        "authorized_official_last_name": "BANKEN",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "SR. VICE PRSIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "602-335-2095",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Home",
            "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 Oct 9, 2012; 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.