Provider Demographics
NPI:1437938461
Name:SYCAMORE SPRINGS SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:SYCAMORE SPRINGS SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:NICK
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-232-0540
Mailing Address - Street 1:165 JERRY BAKER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-9485
Mailing Address - Country:US
Mailing Address - Phone:870-232-0540
Mailing Address - Fax:870-232-0541
Practice Address - Street 1:165 JERRY BAKER LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-9485
Practice Address - Country:US
Practice Address - Phone:870-232-0540
Practice Address - Fax:870-232-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty