Healthcare Provider Details

I. General information

NPI: 1104006444
Provider Name (Legal Business Name): ESTELLE LINDSEY/DBA SEQUOIA RESIDENTIAL FACILITY 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 DUET DR
SILER CITY NC
27344-1603
US

IV. Provider business mailing address

1519 DUET DR
SILER CITY NC
27344-1603
US

V. Phone/Fax

Practice location:
  • Phone: 919-742-2893
  • Fax: 919-718-9596
Mailing address:
  • Phone: 919-742-2893
  • Fax: 919-718-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number019045
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number019045
License Number StateNC

VIII. Authorized Official

Name: MRS. ESTELLE LINDSEY II
Title or Position: OWNER
Credential:
Phone: 919-742-2893