Provider Demographics
NPI:1588789325
Name:SAGEBRUSH INC
Entity type:Organization
Organization Name:SAGEBRUSH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-928-5715
Mailing Address - Street 1:101 W GREER
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662
Mailing Address - Country:US
Mailing Address - Phone:580-928-5715
Mailing Address - Fax:580-928-5775
Practice Address - Street 1:101 W GREER AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-3345
Practice Address - Country:US
Practice Address - Phone:580-928-5715
Practice Address - Fax:580-928-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services