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General NPI Number Information
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NPI Number | 1215445630
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Entity Type | Organization
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Legal Business Name | SAGE CREEK LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 101 N MADISON
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City | MALDEN
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State | MO
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Zip | 63863
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Country | US
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Telephone | 573-281-2103
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Fax | 573-281-2168
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Provider Business Mailing Address
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Address Line | 127 W MAIN ST
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City | MALDEN
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State | MO
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Zip | 63863-2162
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Country | US
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Telephone | 573-281-2103
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Fax | 573-281-2168
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Authorized Official
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Title or Position | OWNER
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Name | JOHN WELCH
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Credential |
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Telephone | 573-276-8916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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