Healthcare Provider Details

I. General information

NPI: 1669677878
Provider Name (Legal Business Name): SAGAL GROUP CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 MOORPARK AVE STE 108
SAN JOSE CA
95128-3158
US

IV. Provider business mailing address

2845 MOORPARK AVE STE 108
SAN JOSE CA
95128-3158
US

V. Phone/Fax

Practice location:
  • Phone: 408-244-7553
  • Fax:
Mailing address:
  • Phone: 408-244-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number2717715
License Number StateCA

VIII. Authorized Official

Name: MR. JAMALI WARFA ATTEYEH
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-244-7553