Healthcare Provider Details

I. General information

NPI: 1396520847
Provider Name (Legal Business Name): SAGAMORE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 THREE HUNTS DR
PEMBROKE NC
28372-8998
US

IV. Provider business mailing address

PO BOX 3781
PEMBROKE NC
28372-3781
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-0408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JHONATHAN STRICKLAND
Title or Position: VP PROGRAM OPERATIONS
Credential:
Phone: 910-522-0408