MEDICARE: SEQUEL YOUTH SERVICES OF FALCON RIDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	8991595-3502	UT

General Provider Information

NPI Number	:	1851831333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUEL YOUTH SERVICES OF FALCON RIDGE

Provider Business Mailing Address
First Line	:	750 E SR 9
Second Line	:
City	:	VIRGIN
State	:	UT
Zip	:	84779-7726
Country	:	US
Telephone Number	:	435-635-5260
Fax Number	:	435-635-5327

Provider Business Practice Location Address
First Line	:	750 E SR 9
Second Line	:
City	:	VIRGIN
State	:	UT
Zip	:	84779-7726
Country	:	US
Telephone Number	:	435-635-5260
Fax Number	:	435-635-5327

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. JENNEIL ANNE GROSS-KRIEVER
Credential	:	CSW
Telephone Number	:	435-635-5260

Provider Enumeration Date	:	03/02/2017
Last Update Date	:	03/02/2017

Similar Medicare Providers

1295188209 — CARE YOUTH CORPORATION
Practice Location Address:

750 E SR 9
VIRGIN, UT
84779-7726

Practice Phone: 435-635-5260
Practice Fax:

1285889873 — FALCON RIDGE RANCH INC
Practice Location Address:

633 E HWY 9
VIRGIN, UT
84779

Practice Phone: 435-673-6111
Practice Fax:

1265749154 — LORNETA HALL FERGUSON LCSW
Practice Location Address:

633 E HWY 9
VIRGIN, UT
84779

Practice Phone: 435-635-4080
Practice Fax:

1548500614 — FALCON RIDGE RANCH NON PROFIT ORGANIZATION
Practice Location Address:

633 E HWY 9
VIRGIN, UT
84779

Practice Phone: 435-635-5260
Practice Fax:

1982150256 — SEQUEL YOUTH SERVICES OF FALCON RIDGE RANCH
Practice Location Address:

633 EAST HIGHWAY
VIRGIN, UT
84779

Practice Phone: 435-635-5260
Practice Fax:

1659914406 — BENJAMIN BARRET HASLAM
Practice Location Address:

1055 E SR 9
VIRGIN, UT
84779-5025

Practice Phone: 435-619-4170
Practice Fax:

Directions to “SEQUEL YOUTH SERVICES OF FALCON RIDGE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.