Healthcare Provider Details

I. General information

NPI: 1417425604
Provider Name (Legal Business Name): SAGEBRUSH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N GOLDEN CIRCLE DR STE A
SANTA ANA CA
92705-3977
US

IV. Provider business mailing address

20500 BELSHAW AVENUE DPT 2034
CARSON CA
90746-3506
US

V. Phone/Fax

Practice location:
  • Phone: 800-778-1772
  • Fax: 714-699-4984
Mailing address:
  • Phone: 949-298-9228
  • Fax: 714-699-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AARON BAILEY
Title or Position: GENERAL COUNSEL
Credential:
Phone: 949-298-9228