Provider Demographics
NPI:1598352411
Name:SAGE AND ENAMEL HOME HEALTHCARE SYSTEM LLC
Entity Type:Organization
Organization Name:SAGE AND ENAMEL HOME HEALTHCARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:SEUN
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-600-1938
Mailing Address - Street 1:2302 W JOHN ST APT 207
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6838
Mailing Address - Country:US
Mailing Address - Phone:224-600-1938
Mailing Address - Fax:
Practice Address - Street 1:2302 W JOHN ST APT 207
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-6838
Practice Address - Country:US
Practice Address - Phone:224-600-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health