Provider Demographics
NPI:1437453727
Name:SAGE COMMUNITY PROVIDERS, INC
Entity Type:Organization
Organization Name:SAGE COMMUNITY PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OSAGIE
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:ODEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-258-4474
Mailing Address - Street 1:12807 ASHFORD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2136
Mailing Address - Country:US
Mailing Address - Phone:504-258-4474
Mailing Address - Fax:
Practice Address - Street 1:12807 ASHFORD MEADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2136
Practice Address - Country:US
Practice Address - Phone:504-258-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800613749251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX800613749Medicaid