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Navajo Health Foundation-Sage Memorial Hospital, Inc.

Organization Active NPI Rural Health Clinic/Center · Ganado, AZ

NPI 1750508651 · NPPES record last updated Nov 14, 2024

Key facts

NPI
1750508651
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
RGH3899 (AZ)
Legal business name
NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL, INC.
Practice address
US 191 & Az 264
Ganado, AZ 86505-0457
Phone
(928) 755-4500
Fax
(928) 755-4932
NPI assigned
Apr 20, 2007
Organization subpart
Yes
Parent organization (as reported)
NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL, INC.

Authorized official

Name
Mrs. Andrea Curley
Title
Medical Staff Credentialist
Phone
(928) 755-4500

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 6

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

Facilities with the same owner 1

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

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 60

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AZ

Rural health clinic certification: CCN 033984

Legal name
NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL, INC.
Doing business as
SAGE OUTPATIENT CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 27, 2000
Last certification
Nov 4, 2020
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Aug 31, 1978 in AZ
Enrollment address
Az Hwy 264 & Hwy 191
Ganado, AZ 86505

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Melinda White
Individual 		Corporate Officer
Chief Executive Officer		 Apr 26, 2023
Tina James-Tafoya
Individual 		Corporate Officer
Chief Operating Officer		 Apr 26, 2023
Navajo Health Foundation-Sage Memorial Hospital, Inc.
Organization · Ganado, AZ 		Operational/Managerial Control Oct 27, 2008
Rachel Goy
Individual 		W-2 Managing Employee Apr 26, 2023

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sage Memorial Hospital
Ganado, AZ · CCN 03Z309		 Hospital Operational/Managerial Control (100%) Jan 1, 1978

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090729000481 AZ Part a Provider - Rural Health Clinic 2163332347 Practice locations: Ganado, AZ

National Provider Directory

Tax ID family
Navajo Health Foundation (7 organizations share this tax ID)
Part of
Navajo Health Foundation

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X RGH3899 AZ Yes

Addresses

Primary practice location

US 191 & Az 264
Ganado, AZ 86505-0457

Mailing address

PO Box 457
Ganado, AZ 86505-0457
Phone (928) 755-4500

Other names

  • Sage Outpatient Clinic Doing business as

Other providers in Ganado, AZ

All providers in Ganado, AZ · Rural Health Clinic/Center in Arizona

Sources for this page

Verify at the official NPI Registry.