Provider Demographics
NPI:1699163485
Name:SAGATA THERA LLC
Entity type:Organization
Organization Name:SAGATA THERA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WURTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-973-2400
Mailing Address - Street 1:9215 RAINBOW CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1481
Mailing Address - Country:US
Mailing Address - Phone:210-620-7700
Mailing Address - Fax:
Practice Address - Street 1:9215 RAINBOW CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1481
Practice Address - Country:US
Practice Address - Phone:210-620-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12744101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty