Provider Demographics
NPI:1356679286
Name:SYCAMORESOUL L.L.C.
Entity Type:Organization
Organization Name:SYCAMORESOUL L.L.C.
Other - Org Name:SEDONAMEDPLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIVANAVAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:928-282-3535
Mailing Address - Street 1:55 SHELBY DR
Mailing Address - Street 2:A-3
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5300
Mailing Address - Country:US
Mailing Address - Phone:928-282-3535
Mailing Address - Fax:928-282-1107
Practice Address - Street 1:55 SHELBY DR
Practice Address - Street 2:A-3
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5300
Practice Address - Country:US
Practice Address - Phone:928-282-3535
Practice Address - Fax:928-282-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies