Organization
SEQUEL TSI OF IDAHO, LLC
Active
Parent organization
SEQUEL TSI HOLDINGS
Other names
Mountain Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
SEQUEL TSI HOLDINGS
Authorized official
MR. CHRIS BANKEN (SR. VICE PRESIDENT OF OPERATIONS)
(602) 335-2095
Entity
Organization
Contact information
Practice address
2850 INDUSTRIAL WAY, MOUNTAIN HOME, ID 83647-3960
(208) 587-2679
Mailing address
2850 INDUSTRIAL WAY, MOUNTAIN HOME, ID 83647-3960
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/10/2012
Last updated
10/10/2012
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