NPIMap

Organization Active NPI

Sage LTAC LLC

Doing business as Sage Specialty Hospital

  • Psychiatric Hospital Unit
  • Denham Springs, LA
National Provider Identifier
1720601586
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
SAGE LTAC LLC
Doing business as
Sage Specialty Hospital
Practice address
8375 Florida Blvd
Denham Springs, LA 70726-7806
Phone
(225) 368-3181
NPI assigned
May 27, 2020
Last updated
May 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Authorized official

Name
Brett Sandifer
Title
Agent
Phone
(225) 368-3181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

8375 Florida Blvd
Denham Springs, LA 70726-7806

Mailing address

10615 Jefferson Hwy
Baton Rouge, LA 70809-7230
Phone (225) 368-3181

Other names 1

  • Sage Specialty Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200630000463 LA Part A Provider - Hospital 3274807219 Practice locations: Denham Springs, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720601586. Details of each certification follow.

Hospital certification: CCN 19SA08

Legal name
SAGE LTAC LLC
Doing business as
SAGE SPECIALTY HOSPITAL-PSYCHIATRIC UNIT
Organization structure
LLCProprietary
Enrollment address
8375 Florida Blvd
Denham Springs, LA 70726-7806
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Sage LTAC LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
PCM Rehab Enterprises LLC Organization, Baton Rouge, LA LLC 5% Or Greater Direct Ownership Interest May 1, 2019 100%
Patrick Thomas Mitchell Individual Operational/Managerial ControlManager Aug 17, 2017
Other May 1, 2019 1%
Sybil Chatman Miles Individual W-2 Managing EmployeeAd; Dec 13, 2021
Kelly Mitchell Individual Other Dec 31, 2020
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%
Paul M. Ross Individual Operational/Managerial ControlAdministrator of Psychiatric Ser Dec 18, 2020

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.

NPI Registry JSON

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590537600000",
    "number": "1720601586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10615 JEFFERSON HWY",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708097230",
            "telephone_number": "225-368-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8375 FLORIDA BLVD",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707267806",
            "telephone_number": "225-368-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE LTAC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-27",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A",
        "authorized_official_last_name": "SANDIFER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "225-368-3181"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sage Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denham Springs, LA

Sources for this page

Verify at the official NPI Registry.