Provider Demographics
NPI:1740961424
Name:SAGACIOUS BEAUTY LLC.
Entity type:Organization
Organization Name:SAGACIOUS BEAUTY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-264-5293
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-2063
Mailing Address - Country:US
Mailing Address - Phone:346-803-6955
Mailing Address - Fax:
Practice Address - Street 1:16770 IMPERIAL VALLEY DR STE 125E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3427
Practice Address - Country:US
Practice Address - Phone:832-264-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAGACIOUS BEAUTY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty