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Organization
SEQUEL TSI OF IDAHO, LLC
Active
Organization
SEQUEL TSI OF IDAHO, LLC
Active
Other names
Mountain Home RTC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN STUPAK (PRESIDENT)
(267) 419-8913
Entity
Organization
Contact information
Practice address
2850 INDUSTRIAL WAY, MOUNTAIN HOME, ID 83647-3960
(208) 587-2679
(208) 587-2875
Mailing address
2850 INDUSTRIAL WAY, MOUNTAIN HOME, ID 83647-3960
(208) 587-2679
(208) 587-2875
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
12/30/2009
Last updated
12/30/2009
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