Healthcare Provider Details

I. General information

NPI: 1104473438
Provider Name (Legal Business Name): SAGE LTAC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7806
US

IV. Provider business mailing address

10615 JEFFERSON HWY
BATON ROUGE LA
70809-7230
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-2664
  • Fax:
Mailing address:
  • Phone: 225-368-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICK MITCHELL
Title or Position: MANAGER
Credential:
Phone: 225-368-3181