MEDICARE: WOODLAND SAGE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1437991833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND SAGE HOME CARE LLC

Provider Business Mailing Address
First Line	:	9311 TONKAWA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-5509
Country	:	US
Telephone Number	:	216-926-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	9311 TONKAWA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-5509
Country	:	US
Telephone Number	:	216-926-0410
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	EDEN KIDANE
Credential	:
Telephone Number	:	216-926-0410

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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