Provider Demographics
NPI:1700130408
Name:SAGE HOLISTIC HEALTHCARE
Entity Type:Organization
Organization Name:SAGE HOLISTIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:561-703-7830
Mailing Address - Street 1:301 CRAWFORD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3777
Mailing Address - Country:US
Mailing Address - Phone:561-703-7830
Mailing Address - Fax:
Practice Address - Street 1:301 CRAWFORD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3777
Practice Address - Country:US
Practice Address - Phone:561-703-7830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty