Provider Demographics
NPI:1417572785
Name:SAGEWOOD, INC.
Entity Type:Organization
Organization Name:SAGEWOOD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:FASS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:814-362-5579
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-0370
Mailing Address - Country:US
Mailing Address - Phone:814-362-5579
Mailing Address - Fax:814-368-5997
Practice Address - Street 1:63 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1369
Practice Address - Country:US
Practice Address - Phone:814-598-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health