MEDICARE: SAGEBROOK BEHAVIORAL HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063394567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGEBROOK BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	160 MOORE DR STE 205
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2951
Country	:	US
Telephone Number	:	859-489-4126
Fax Number	:	859-214-7634

Provider Business Practice Location Address
First Line	:	160 MOORE DR STE 205
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2951
Country	:	US
Telephone Number	:	859-457-1904
Fax Number	:	859-214-7634

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAY I MIREMBO
Credential	:	MD
Telephone Number	:	859-489-4126

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	12/05/2025

Similar Medicare Providers

1679404354 — ERIN OLIVIA MANUEL APRN
Practice Location Address:

160 MOORE DR STE 205
LEXINGTON, KY
40503-2951

Practice Phone: 859-489-4126
Practice Fax:

1811137441 — DR. DENNIS R. NORTHRIP M.D.
Practice Location Address:

2416 REGENCY ROAD
LEXINGTON, KY
40503-2951

Practice Phone: 859-278-1316
Practice Fax: 859-276-1574

1023690260 — RAY ISINGA MIREMBO
Practice Location Address:

160 MOORE DR STE 205
LEXINGTON, KY
40503-2951

Practice Phone: 859-489-4126
Practice Fax: 859-214-7634

1114858669 — ANN-MARIA BAAS MS, RD
Practice Location Address:

2101 NICHOLASVILLE RD STE 108
LEXINGTON, KY
40503-2537

Practice Phone: 859-260-6356
Practice Fax: 859-277-0616

1164352217 — MADISON CHARLOTTE NITZ
Practice Location Address:

900 SOUTH LIMESTONE ST
LEXINGTON, KY
40503

Practice Phone: 859-323-1100
Practice Fax:

1316879828 — DR. JOHANN MANI PHARMD, BCPS
Practice Location Address:

1740 NICHOLASVILLE RD
LEXINGTON, KY
40503-1431

Practice Phone: 859-260-6659
Practice Fax:

Directions to “SAGEBROOK BEHAVIORAL HEALTH PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.