Provider Demographics
NPI:1336544238
Name:SAGE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SAGE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSS
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-375-3324
Mailing Address - Street 1:4131 JUSTIN SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41044-9011
Mailing Address - Country:US
Mailing Address - Phone:606-375-3324
Mailing Address - Fax:
Practice Address - Street 1:4131 JUSTIN SCOTT LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:KY
Practice Address - Zip Code:41044-9011
Practice Address - Country:US
Practice Address - Phone:606-375-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN282108251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109574Medicaid