SAGEBRUSH LLC (NPI# 1417425604) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417425604 |
| Entity Type | Organization |
| Organization Name | SAGEBRUSH LLC |
| Practice Address |
1349 Avolencia Dr Fullerton CA 92835-3702 |
| Mailing Address |
1217 Linda Ln Fullerton CA 92831-2001 |
| Practice Telephone | 8006743412 |
| Practice Fax Number | 8006743412 |
| Mailing Telephone | 8006743412 |
| Mailing Fax Number | 8006743412 |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2018-11-06 |
| Authorized Official Name | JOHN KOHLBECK (OFFICER) |
| Authorized Official Telephone | 7142777501 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| The Edge Detox | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | SAGEBRUSH LLC | 100 Brooklyn Avenue, Suite 1k, Freeport, Ny 11520 |
| Street Address |
1349 AVOLENCIA DR |
| City | FULLERTON |
| State | CA |
| Zip Code | 92835-3702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538774302 | Natalie Baugh | Nutritionist | 333 W Bastanchury Rd 110, Fullerton, CA 92835 | 2020-09-09 |
| 1073127098 | Cecile Mae Sam | Physical Therapist | 2932 Clover Ct, Fullerton, CA 92835 | 2020-09-08 |
| 1861966087 | Kimson F Johnston | Marriage & Family Therapist | 1370 Brea Blvd Suite 210, Fullerton, CA 92835 | 2019-01-22 |
| 1134636327 | Michelle Harriman, Psychologist - A Professional Corporation | Psychologist | 1440 N Harbor Blvd Ste 808, Fullerton, CA 92835 | 2018-01-09 |
| 1659818631 | Jacqueline Rene Miller | Specialist/Technologist | 2610 Associated Rd, Apt A4, Fullerton, CA 92835 | 2017-01-27 |
| 1912361106 | John Nathaniel Alvarez | Psychiatry & Neurology | 401 E Imperial Highway, Fullerton, CA 92835 | 2016-04-13 |
| 1083075030 | Advance Recovery Solution, LLC | Substance Abuse Rehabilitation Facility | 3744 N Hermosa Pl, Fullerton, CA 92835 | 2016-03-17 |
| 1467817981 | Michele Ledesma | Physical Therapy Assistant | 2800 N. Harbor Blvd., Fullerton, CA 92835 | 2015-12-29 |
| 1467820571 | Jonghan Kang | Acupuncturist | 1321 N Harbor Blvd Ste 205, Fullerton, CA 92835 | 2015-09-04 |
| 1265840987 | Allison Leigh Kennedy | Physician Assistant | 100 Laguna Rd Ste 208, Fullerton, CA 92835 | 2014-07-25 |
| Find all providers in zip 92835 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326480542 | Sage Behavior Services | Community/Behavioral Health | 1435 N Harbor Blvd, 124, Fullerton, CA 92835-4105 | 2013-07-30 |
| 1477894632 | Jr Estrella | Community/Behavioral Health | 801 S Harbor Blvd, Fullerton, CA 92832-3022 | 2013-03-12 |
| 1871737056 | Alta Institute, Inc. | Community/Behavioral Health | 524 W.. Commonwealth Avenue, Suite K, Fullerton, CA 92832-1764 | 2009-05-01 |
| 1184716581 | Korean Community Services | Community/Behavioral Health | 1060 S Brookhurst Rd, Fullerton, CA 92833-3709 | 2006-09-30 |
| 1255996880 | Brave Relationships Family Therapy and Professional Consulting | Community/Behavioral Health | 1440 N Harbor Blvd Ste 900, Fullerton, CA 92835-4122 | 2019-05-09 |
| 1972045409 | Yasamin Farhad, Lmft | Community/Behavioral Health | 2601 E Chapman Ave Ste 102, Fullerton, CA 92831-3737 | 2016-11-15 |
| 1649712258 | Autism Spectrum Interventions | Community/Behavioral Health | 713 W Commonwealth Ave Ste C, Fullerton, CA 92832-1612 | 2016-11-14 |
| 1609249267 | Kc Services | Community/Behavioral Health | 1060 S Brookhurst Rd, Fullerton, CA 92833-3709 | 2015-11-04 |
| 1861886418 | Omid Multicultural Institute for Development | Community/Behavioral Health | 2601 E Chapman Ave, Suite 116, Fullerton, CA 92831-3737 | 2015-03-21 |
| 1396135208 | Andrade Family Therapy | Community/Behavioral Health | 305 N Harbor Blvd, Suite 215, Fullerton, CA 92832-1990 | 2015-01-29 |
| Find all providers in FULLERTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.