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General NPI Number Information
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NPI Number | 1992036156
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Entity Type | Organization
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Legal Business Name | SEQUEL TSI OF PAINT ROCK VALLEY, LLC
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 3890 COUNTY ROAD 20
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City | TRENTON
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State | AL
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Zip | 35774-7423
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Country | US
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Telephone | 256-776-2503
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Fax | 256-776-2561
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Provider Business Mailing Address
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Address Line | 3890 COUNTY ROAD 20
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City | TRENTON
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State | AL
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Zip | 35774-7423
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Country | US
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Telephone | 256-776-2503
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Fax | 256-776-2561
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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 | 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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