Organization
SEQUEL TSI OF AZ, LLC
Active
Parent organization
SEQUELCARE OF AZ, LLC
Other names
Traditions Kayenta
Organization subpart
Yes
Provider details
NPI number
Legal business name
SEQUELCARE OF AZ, LLC
Authorized official
CHRIS BANKEN (EXECUTIVE DIRECTOR)
(602) 335-2095
Entity
Organization
Contact information
Practice address
HIGHWAY 163, KAYENTA MOBILE HOME PARK #8, KAYENTA, AZ 86033
(928) 697-3154
(928) 697-3156
Mailing address
HIGHWAY 163, KAYENTA MOBILE HOME PARK #8, KAYENTA, AZ 86033
(928) 697-3154
(928) 697-3156
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/31/2009
Last updated
12/31/2009
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