Basic Information
| Provider Information | |||||||||
| NPI: | 1073069340 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEQUEL YOUTH SERVICES OF MT. PLEASANT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MT PLEASANT ACADEMY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1131 EAGLETREE LN SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568803339 | ||||||||
| FaxNumber: | 2568807026 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 SOUTH 70 WEST | ||||||||
| Address2: | |||||||||
| City: | MT. PLEASANT | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018994111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MOSES | ||||||||
| AuthorizedOfficialFirstName: | MANDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF PROGRAM OFFICER/EVP | ||||||||
| AuthorizedOfficialTelephone: | 2568803339 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARE YOUTH CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.