=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588454763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGEBRUSH RECOVERY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 1/2 F ST STE 12
-----------------------------------------------------
City | SALIDA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81201-2141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-688-1235
-----------------------------------------------------
Fax | 970-780-4415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 88
-----------------------------------------------------
City | BAILEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80421-0088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-688-1235
-----------------------------------------------------
Fax | 970-780-4415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR, FOUNDER
-----------------------------------------------------
Name | CARRIE ELLIOTT
-----------------------------------------------------
Credential | CPFS
-----------------------------------------------------
Telephone | 720-688-1235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------