Provider Demographics
| NPI: | 1962094748 |
|---|---|
| Name: | SARAH STREET, LLC |
| Entity type: | Organization |
| Organization Name: | SARAH STREET, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRES/CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TROY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MARSAW |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 713-942-8100 |
| Mailing Address - Street 1: | 3007 CAROLINE ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HOUSTON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77004-2822 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 713-942-8100 |
| Mailing Address - Fax: | 713-533-1408 |
| Practice Address - Street 1: | 3455 SARAH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | BEAUMONT |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77705-2906 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 713-942-8100 |
| Practice Address - Fax: | 713-533-1408 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2021-02-03 |
| Last Update Date: | 2021-04-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
