Healthcare Provider Details

I. General information

NPI: 1164839981
Provider Name (Legal Business Name): SAGE PROJECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 12TH ST
SAN FRANCISCO CA
94103-1297
US

IV. Provider business mailing address

68 12TH ST
SAN FRANCISCO CA
94103-1297
US

V. Phone/Fax

Practice location:
  • Phone: 415-905-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberIMF79243
License Number StateCA

VIII. Authorized Official

Name: ALLEN WILSON
Title or Position: GRANTS & CONTRACTS MANAGER
Credential:
Phone: 415-551-0493