Provider Demographics
NPI:1235750977
Name:SAGAMAR BEHAVIORAL CARE HOME, LLC
Entity Type:Organization
Organization Name:SAGAMAR BEHAVIORAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-899-1114
Mailing Address - Street 1:4444 N 13TH PL APT 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4584
Mailing Address - Country:US
Mailing Address - Phone:323-899-1114
Mailing Address - Fax:
Practice Address - Street 1:4444 N 13TH PL APT 3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4584
Practice Address - Country:US
Practice Address - Phone:323-899-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility