1316616246 NPI number — SAGE ELITE HEALING LLC

Table of content: (NPI 1316616246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316616246 NPI number — SAGE ELITE HEALING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAGE ELITE HEALING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAGE ELITE HEALING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316616246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 271327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80027-5026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-460-7660
Provider Business Mailing Address Fax Number:
303-648-6686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 CANYON BLVD
Provider Second Line Business Practice Location Address:
STE 200B
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80302-5367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-460-7660
Provider Business Practice Location Address Fax Number:
303-648-6686
Provider Enumeration Date:
09/13/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAN STEENBERG
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER / CEO
Authorized Official Telephone Number:
720-460-7660

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)