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General NPI Number Information
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NPI Number | 1336478304
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Entity Type | Organization
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Legal Business Name | SEQUEL TSI OF FLORIDA, LLC MARION PROGRAM
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 10420 NW GAINESVILLE RD
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City | OCALA
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State | FL
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Zip | 34482-1446
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Country | US
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Telephone | 352-840-8240
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Fax | 352-840-8256
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Provider Business Mailing Address
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Address Line | 10420 NW GAINESVILLE RD
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City | OCALA
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State | FL
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Zip | 34482-1446
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Country | US
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Telephone | 352-840-8240
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Fax | 352-840-8256
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN STUPAK
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Credential |
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Telephone | 267-419-8913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 0542AD9709
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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