Provider Demographics
NPI:1215445630
Name:SAGE CREEK LLC
Entity type:Organization
Organization Name:SAGE CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-276-8916
Mailing Address - Street 1:127 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-2162
Mailing Address - Country:US
Mailing Address - Phone:573-281-2103
Mailing Address - Fax:573-281-2168
Practice Address - Street 1:101 N MADISON
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863
Practice Address - Country:US
Practice Address - Phone:573-281-2103
Practice Address - Fax:573-281-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty