MEDICARE: BLUE SAGE ADULT FAMILY HOME 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1518892165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SAGE ADULT FAMILY HOME LLC

Provider Business Mailing Address
First Line	:	5006 BLUE SAGE DR
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-4015
Country	:	US
Telephone Number	:	509-572-8984
Fax Number	:	509-219-3500

Provider Business Practice Location Address
First Line	:	5006 BLUE SAGE DR
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-4015
Country	:	US
Telephone Number	:	509-572-8984
Fax Number	:	509-219-3500

Authorized Official
Title or Position	:	OWNER
Name	:	ADWOA YEBOAH
Credential	:
Telephone Number	:	509-572-8984

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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