MEDICARE: SEQUEL YOUTH SERVICES OF FALCON RIDGE RANCH

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	320800000X	Mental Illness Community Based Residential Treatment Facility
2	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1982150256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUEL YOUTH SERVICES OF FALCON RIDGE RANCH

Provider Business Mailing Address
First Line	:	2560 BUSINESS PKWY STE A
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423
Country	:	US
Telephone Number	:	435-635-5260
Fax Number	:	256-880-7026

Provider Business Practice Location Address
First Line	:	633 EAST HIGHWAY
Second Line	:
City	:	VIRGIN
State	:	UT
Zip	:	84779
Country	:	US
Telephone Number	:	435-635-5260
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MARANDA FIGULI
Credential	:
Telephone Number	:	480-987-2080

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	08/14/2025

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