Provider Demographics
NPI:1538823737
Name:SACRED HEALTH INCORPORATED
Entity type:Organization
Organization Name:SACRED HEALTH INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:GAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-604-2090
Mailing Address - Street 1:1071 MATCHSTICK PL SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4706
Mailing Address - Country:US
Mailing Address - Phone:704-604-2090
Mailing Address - Fax:
Practice Address - Street 1:3416 VIRGINIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-2240
Practice Address - Country:US
Practice Address - Phone:276-403-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health