MEDICARE: SEQUOIA, INC.

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	261QD1600X	Developmental Disabilities Clinic/Center		TX

General Provider Information

NPI Number	:	1275724023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUOIA, INC.

Provider Business Mailing Address
First Line	:	2438 BUTLER ST STE 104
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7880
Country	:	US
Telephone Number	:	214-634-3431
Fax Number	:	214-905-1114

Provider Business Practice Location Address
First Line	:	2438 BUTLER ST STE 104
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7880
Country	:	US
Telephone Number	:	214-634-3431
Fax Number	:	214-905-1114

Authorized Official
Title or Position	:	DIRECTOR OF PROGRAMS
Name	:	SARAH ELLIOTT
Credential	:
Telephone Number	:	214-634-3431

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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