Organization
SAGE LAKE HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANONNE THOMAS (OWNER/DIRECTOR OF ADMINISTRATION)
(678) 506-1880
Entity
Organization
Contact information
Practice address
1775 PARKER RD SE STE 210, CONYERS, GA 30094-6654
(678) 506-1880
Mailing address
2710 RATBY LN NE, CONYERS, GA 30013-1875
(678) 506-1880
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
12/02/2018
Last updated
08/18/2021
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