NPIMap

Organization Active NPI

Cactus Sage LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1902494941
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
CACTUS SAGE LLC
Practice address
3424 E Coronado Rd
Phoenix, AZ 85008-3826
Phone
(623) 225-1240
NPI assigned
Jan 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Geraldine Mutwol
Title
Ceo
Phone
(623) 225-1240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

3424 E Coronado Rd
Phoenix, AZ 85008-3826

Mailing address

3848 E Pollack St
Phoenix, AZ 85042-6207
Phone (623) 225-1240

Other identifiers 1

IdentifierTypeStateIssuer
BH6562OtherAZAZDHS

National Provider Directory

National Provider Directory
Tax ID family
Cactus Sage 23 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1902494941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3848 E POLLACK ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850426207",
            "telephone_number": "623-225-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3424 E CORONADO RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850083826",
            "telephone_number": "623-225-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CACTUS SAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "MUTWOL",
        "authorized_official_first_name": "GERALDINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "623-225-1240",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZDHS",
            "identifier": "BH6562",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.