Provider Demographics
NPI:1417425604
Name:SAGEBRUSH LLC
Entity Type:Organization
Organization Name:SAGEBRUSH LLC
Other - Org Name:THE EDGE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-298-9228
Mailing Address - Street 1:20500 BELSHAW AVENUE DPT 2034
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3506
Mailing Address - Country:US
Mailing Address - Phone:949-298-9228
Mailing Address - Fax:714-699-4984
Practice Address - Street 1:550 N GOLDEN CIRCLE DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3977
Practice Address - Country:US
Practice Address - Phone:800-778-1772
Practice Address - Fax:714-699-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder