Provider Demographics
NPI:1447339403
Name:SAGE PROJECT, INC
Entity type:Organization
Organization Name:SAGE PROJECT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRANTS & CONTRACTS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-551-0493
Mailing Address - Street 1:68 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1297
Mailing Address - Country:US
Mailing Address - Phone:415-905-5050
Mailing Address - Fax:415-554-1914
Practice Address - Street 1:68 12TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1297
Practice Address - Country:US
Practice Address - Phone:415-905-5050
Practice Address - Fax:415-554-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01538306Medicare PIN