MEDICARE: SACRED HEALTH INCORPORATED

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1538823737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED HEALTH INCORPORATED

Provider Business Mailing Address
First Line	:	1071 MATCHSTICK PL SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-4706
Country	:	US
Telephone Number	:	704-604-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	3416 VIRGINIA AVE STE 3
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-2240
Country	:	US
Telephone Number	:	276-403-0258
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. WILLIAM BERNARD GAUSE
Credential	:
Telephone Number	:	704-604-2090

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	10/25/2021

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Directions to “SACRED HEALTH INCORPORATED ” Practice Location

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