Provider Demographics
NPI:1396289476
Name:PURPLE SAGE TELE-HOME HEALTH LLC
Entity type:Organization
Organization Name:PURPLE SAGE TELE-HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-321-7510
Mailing Address - Street 1:606 23RD ST
Mailing Address - Street 2:PO BOX 724
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5127
Mailing Address - Country:US
Mailing Address - Phone:307-321-7510
Mailing Address - Fax:
Practice Address - Street 1:606 23RD ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5127
Practice Address - Country:US
Practice Address - Phone:307-321-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health