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NPI Code Detail

MEDICARE: SEQUEL YOUTH SERVICES OF ALBION, LLC

MEDICARE: SEQUEL YOUTH SERVICES OF ALBION, LLC
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
1253J00000XFoster Care Agency

General Provider Information

NPI Number : 1366832206
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEQUEL YOUTH SERVICES OF ALBION, LLC
Provider Business Mailing Address
First Line : 13725 26 MILE RD
Second Line :
City : ALBION
State : MI
Zip : 49224-9525
Country : US
Telephone Number : 517-629-5591
Fax Number :
Provider Business Practice Location Address
First Line : 13725 26 MILE RD
Second Line :
City : ALBION
State : MI
Zip : 49224-9525
Country : US
Telephone Number : 517-629-5591
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : RANDY COPAS
Credential :
Telephone Number : 517-629-5591
Provider Enumeration Date : 01/30/2015
Last Update Date : 01/30/2015

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