Provider Demographics
NPI:1831911718
Name:SAGE PRIVATE CARE LTD CO
Entity type:Organization
Organization Name:SAGE PRIVATE CARE LTD CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVENIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCRIVEN JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-750-5393
Mailing Address - Street 1:5055 MEMORIAL DR STE A347
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3108
Mailing Address - Country:US
Mailing Address - Phone:770-750-5393
Mailing Address - Fax:
Practice Address - Street 1:1992 WYNHURST XING
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-4241
Practice Address - Country:US
Practice Address - Phone:770-750-5393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty