Healthcare Provider Details

I. General information

NPI: 1326904988
Provider Name (Legal Business Name): SAGE WEST WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 CENTRAL AVE STE 58388
CHEYENNE WY
82001-4531
US

IV. Provider business mailing address

1621 CENTRAL AVE STE 58388
CHEYENNE WY
82001-4531
US

V. Phone/Fax

Practice location:
  • Phone: 970-316-8300
  • Fax:
Mailing address:
  • Phone: 970-316-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT KNOWLES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 970-316-8300