Provider Demographics
NPI:1982992087
Name:SAGE NUTRITION, LLC
Entity type:Organization
Organization Name:SAGE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:610-977-2076
Mailing Address - Street 1:150 N RADNOR CHESTER RD
Mailing Address - Street 2:STE F-200
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5252
Mailing Address - Country:US
Mailing Address - Phone:610-977-2076
Mailing Address - Fax:610-977-0043
Practice Address - Street 1:150 N RADNOR CHESTER RD
Practice Address - Street 2:STE F-200
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5252
Practice Address - Country:US
Practice Address - Phone:610-977-2076
Practice Address - Fax:610-977-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002004133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty