Provider Demographics
NPI:1598114217
Name:SAGE CARE HOME, LLC.
Entity Type:Organization
Organization Name:SAGE CARE HOME, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERILYN
Authorized Official - Middle Name:AUNG
Authorized Official - Last Name:BERGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-332-6079
Mailing Address - Street 1:13519 NIGHT STAR LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-9891
Mailing Address - Country:US
Mailing Address - Phone:661-332-6079
Mailing Address - Fax:
Practice Address - Street 1:13519 NIGHT STAR LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-9891
Practice Address - Country:US
Practice Address - Phone:661-332-6079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157207097310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility