Provider Demographics
NPI:1851106686
Name:SACRED OAK LLC
Entity type:Organization
Organization Name:SACRED OAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JH
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CNH
Authorized Official - Phone:207-991-3996
Mailing Address - Street 1:696 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1492
Mailing Address - Country:US
Mailing Address - Phone:207-991-3996
Mailing Address - Fax:
Practice Address - Street 1:191 S MAIN ST UNIT 3
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2307
Practice Address - Country:US
Practice Address - Phone:207-991-3996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty