Provider Demographics
NPI:1750362190
Name:SAGE REHABILITATION INSTITUTE LLC
Entity type:Organization
Organization Name:SAGE REHABILITATION INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-906-4878
Mailing Address - Street 1:8000 SUMMA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3423
Mailing Address - Country:US
Mailing Address - Phone:225-819-0703
Mailing Address - Fax:225-906-4085
Practice Address - Street 1:8000 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3423
Practice Address - Country:US
Practice Address - Phone:225-819-0703
Practice Address - Fax:225-906-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA474283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1700576Medicaid
LA193078Medicare ID - Type Unspecified