Organization
CACTUS SAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GERALDINE MUTWOL (CEO)
(623) 225-1240
Entity
Organization
Contact information
Practice address
3424 E CORONADO RD, PHOENIX, AZ 85008-3826
(623) 225-1240
Mailing address
3848 E POLLACK ST, PHOENIX, AZ 85042-6207
(623) 225-1240
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6562
AZDHS
AZ
Enumeration date
01/05/2021
Last updated
01/05/2021
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