Healthcare Provider Details

I. General information

NPI: 1336961382
Provider Name (Legal Business Name): SL SAGE HARBOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIDD CASTLE WAY
WEBSTER NY
14580-1963
US

IV. Provider business mailing address

100 KIDD CASTLE WAY
WEBSTER NY
14580-1963
US

V. Phone/Fax

Practice location:
  • Phone: 585-670-7330
  • Fax:
Mailing address:
  • Phone: 585-670-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN J LEVY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 312-673-4387