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General NPI Number Information
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NPI Number | 1235750977
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Entity Type | Organization
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Legal Business Name | SAGAMAR BEHAVIORAL CARE HOME, LLC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 4444 N 13TH PL APT 3
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City | PHOENIX
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State | AZ
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Zip | 85014-4584
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Country | US
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Telephone | 323-899-1114
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Fax |
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Provider Business Mailing Address
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Address Line | 4444 N 13TH PL APT 3
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City | PHOENIX
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State | AZ
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Zip | 85014-4584
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Country | US
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Telephone | 323-899-1114
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. NORMAN V MARIN
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Credential |
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Telephone | 323-899-1114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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