Provider Demographics
NPI:1376655092
Name:SAGE REHABILITATION INC
Entity Type:Organization
Organization Name:SAGE REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KUSHALRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PUKHRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:815-690-2100
Mailing Address - Street 1:2814 STACIA CT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9218
Mailing Address - Country:US
Mailing Address - Phone:815-690-2100
Mailing Address - Fax:815-254-8267
Practice Address - Street 1:2814 STACIA CT
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9218
Practice Address - Country:US
Practice Address - Phone:815-690-2100
Practice Address - Fax:815-254-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty