Provider Demographics
NPI:1942834452
Name:ROYAL SAGE LLC
Entity Type:Organization
Organization Name:ROYAL SAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLUSHOLA
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:ODEGBAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-548-3124
Mailing Address - Street 1:884 DAVIS ST APT 308
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1500
Mailing Address - Country:US
Mailing Address - Phone:415-548-3124
Mailing Address - Fax:
Practice Address - Street 1:884 DAVIS ST APT 308
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1500
Practice Address - Country:US
Practice Address - Phone:415-548-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)