Provider Demographics
NPI:1992944557
Name:SEQUEL OF NEW MEXICO, LLC
Entity type:Organization
Organization Name:SEQUEL OF NEW MEXICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MARKETING & CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GURULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-710-9210
Mailing Address - Street 1:5400 GIBSON BLVD., SE
Mailing Address - Street 2:SUITE 'A'
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108
Mailing Address - Country:US
Mailing Address - Phone:505-924-6330
Mailing Address - Fax:505-768-7956
Practice Address - Street 1:1801 RANDOLPH RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4230
Practice Address - Country:US
Practice Address - Phone:505-924-6330
Practice Address - Fax:505-768-7956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUET YOUTH AND FAMILY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-05
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320600000X
NM2020320600000X
NM2021320600000X
NM2022320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM#96128259Medicaid