Provider Demographics
NPI:1528001427
Name:SAGEBROOK HEALTH CENTER INC
Entity Type:Organization
Organization Name:SAGEBROOK HEALTH CENTER INC
Other - Org Name:SAGEBROOK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-703-2193
Mailing Address - Street 1:901 DISCOVERY BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2273
Mailing Address - Country:US
Mailing Address - Phone:512-259-9993
Mailing Address - Fax:512-259-8262
Practice Address - Street 1:901 DISCOVERY BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2273
Practice Address - Country:US
Practice Address - Phone:512-259-9993
Practice Address - Fax:512-259-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001151314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004077Medicaid
TX675937Medicare ID - Type UnspecifiedMEDICARE PROVIDER #