Provider Demographics
NPI:1851923098
Name:SAGE NUTRITION, LLC
Entity Type:Organization
Organization Name:SAGE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELZINGA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:541-452-3844
Mailing Address - Street 1:1220 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2521
Mailing Address - Country:US
Mailing Address - Phone:541-452-3844
Mailing Address - Fax:
Practice Address - Street 1:1220 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2521
Practice Address - Country:US
Practice Address - Phone:541-452-3844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health