MEDICARE: SAGENCY LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1093398034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGENCY LLC

Provider Business Mailing Address
First Line	:	39620 WASHINGTON ST STE C
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-4137
Country	:	US
Telephone Number	:	619-817-9461
Fax Number	:

Provider Business Practice Location Address
First Line	:	39620 WASHINGTON ST STE C
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-4137
Country	:	US
Telephone Number	:	619-817-9461
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAVAD AGHALOO
Credential	:
Telephone Number	:	619-817-9461

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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