Provider Demographics
NPI:1649589623
Name:SAGE HOUSE ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:SAGE HOUSE ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSM
Authorized Official - Phone:310-832-6031
Mailing Address - Street 1:138 S BANDINI ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2321
Mailing Address - Country:US
Mailing Address - Phone:310-832-6031
Mailing Address - Fax:310-832-6677
Practice Address - Street 1:138 S BANDINI ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2321
Practice Address - Country:US
Practice Address - Phone:310-832-6031
Practice Address - Fax:310-832-6677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198600603261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care