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Organization Active NPI

Sage Rehab Hospital of Lafayette Operations, LLC

Doing business as Sage Specialty and Rehabilitation Center of Lafayette Rehab DPU

  • Rehabilitation Hospital Unit
  • Lafayette, LA
National Provider Identifier
1699499269
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
SAGE REHAB HOSPITAL OF LAFAYETTE OPERATIONS, LLC
Doing business as
Sage Specialty and Rehabilitation Center of Lafayette Rehab DPU
Practice address
204 Energy Pkwy Ste E
Lafayette, LA 70508-3816
Phone
(337) 446-4300
Fax
(866) 815-7594
NPI assigned
Sep 28, 2022
Last updated
Sep 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Patrick Mitchell
Title
Manager
Phone
(225) 368-3181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X NU Primary

Addresses

Primary practice location

204 Energy Pkwy Ste E
Lafayette, LA 70508-3816

Mailing address

204 Energy Pkwy Ste E
Lafayette, LA 70508-3816
Phone (337) 446-4300

Other names 1

  • Sage Specialty and Rehabilitation Center of Lafayette Rehab DPU Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221013002295 LA Part A Provider - Hospital 2365855301 Practice locations: Lafayette, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699499269. Details of each certification follow.

Hospital certification: CCN 19TA57

Legal name
SAGE REHAB HOSPITAL OF LAFAYETTE OPERATIONS, LLC
Doing business as
SAGE SPECIALTY AND REHABILITATION CENTER OF LAFAYETTE REHAB DPU
Organization structure
LLCProprietary
Incorporated
Oct 9, 2020 in LA
Enrollment address
204 Energy Pkwy
Ste E
Lafayette, LA 70508-3816
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Sage Specialty and Rehabilitation Center of LafayeCCN 19TA57 · All quality measures
Ownership
For profit
Certified
Jan 1, 2023

National Provider Directory

National Provider Directory

Locations

204 Energy Pkwy
Ste E
Lafayette, LA 70508
Phone (337) 446-4300

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Leah Formby Individual W-2 Managing EmployeeAd; Jan 1, 2023
PCM Rehab Enterprises LLC Organization, Baton Rouge, LA LLC 5% Or Greater Direct Ownership Interest Nov 20, 2020 100%
Patrick Thomas Mitchell Individual Operational/Managerial ControlManager/Ceo Jan 1, 2023
Other Nov 20, 2020 1%
Kelly Mitchell Individual Other Dec 31, 2022
PCM Intermediate Holdings LLC Organization, Baton Rouge, LA LLC, Holding company 5% Or Greater Indirect Ownership Interest Jul 18, 2025 100%
PTM 2018 Family Trust Organization, Baton Rouge, LA 5% Or Greater Indirect Ownership Interest Dec 31, 2022 99%
Emily Holleman Individual Other Dec 31, 2022
PCM Holdings I, Inc. Organization, Baton Rouge, LA Corporation, Holding company 5% Or Greater Indirect Ownership Interest Jul 18, 2025 100%

Facilities with the same owner 35

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 35

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1699499269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 ENERGY PKWY STE E",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083816",
            "telephone_number": "337-446-4300",
            "fax_number": "866-815-7594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 ENERGY PKWY STE E",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083816",
            "telephone_number": "337-446-4300",
            "fax_number": "866-815-7594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE REHAB HOSPITAL OF LAFAYETTE OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "225-368-3181"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sage Specialty and Rehabilitation Center of Lafayette Rehab DPU",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.