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General NPI Number Information
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NPI Number | 1558752972
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Entity Type | Organization
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Legal Business Name | SAGE PROGRAM, LLC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 8 LUXURY DR
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City | NEWPORT
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State | NH
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Zip | 03773-1495
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Country | US
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Telephone | 727-481-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 8 LUXURY DR
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City | NEWPORT
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State | NH
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Zip | 03773-1495
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Country | US
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Telephone | 727-481-3581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARMAINE W KELLER
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Credential | LCSW,LICSW, CAP
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Telephone | 727-481-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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