MEDICARE: SAGAL GROUP CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320700000X	Physical Disabilities Residential Treatment Facility	2717715	CA

General Provider Information

NPI Number	:	1669677878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGAL GROUP CARE, INC

Provider Business Mailing Address
First Line	:	2845 MOORPARK AVE STE 108
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3158
Country	:	US
Telephone Number	:	408-244-7553
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 MOORPARK AVE STE 108
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3158
Country	:	US
Telephone Number	:	408-244-7553
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JAMALI WARFA ATTEYEH
Credential	:
Telephone Number	:	408-244-7553

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	08/22/2020

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