Healthcare Provider Details

I. General information

NPI: 1356166573
Provider Name (Legal Business Name): SAGEBRUSH HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 CAMINO DE LA TIERRA
CORRALES NM
87048-6909
US

IV. Provider business mailing address

948 CAMINO DE LA TIERRA
CORRALES NM
87048-6909
US

V. Phone/Fax

Practice location:
  • Phone: 956-516-0270
  • Fax:
Mailing address:
  • Phone: 956-516-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AIMEE GARCIA
Title or Position: DIRECTOR
Credential:
Phone: 956-516-0270