Provider Demographics
NPI:1225608656
Name:BLUE SAGE RECOVERY LLC
Entity Type:Organization
Organization Name:BLUE SAGE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/COO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSAC
Authorized Official - Phone:480-356-4370
Mailing Address - Street 1:11527 E STARKEY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-7118
Mailing Address - Country:US
Mailing Address - Phone:480-356-4370
Mailing Address - Fax:
Practice Address - Street 1:155 E RAY RD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3303
Practice Address - Country:US
Practice Address - Phone:480-356-4370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)