MEDICARE: SAGE WAGE 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	332BN1400X	Nursing Facility Supplies (DME)

General Provider Information

NPI Number	:	1669983631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE WAGE LLC

Provider Business Mailing Address
First Line	:	277 SAYBROOK RD SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-7129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAYBROOK RD SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-7129
Country	:	US
Telephone Number	:	321-795-0486
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	NICOLE REVELL
Credential	:
Telephone Number	:	321-795-0486

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	10/18/2017

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Directions to “SAGE WAGE LLC ” Practice Location

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