Provider Demographics
NPI:1528197159
Name:SYCAMORE REHABILITATION SERVICES
Entity Type:Organization
Organization Name:SYCAMORE REHABILITATION SERVICES
Other - Org Name:SYCAMORE SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-745-4715
Mailing Address - Street 1:8313 EAST CO. RD. 300 S.
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168
Mailing Address - Country:US
Mailing Address - Phone:317-838-7705
Mailing Address - Fax:317-838-7707
Practice Address - Street 1:8313 EAST CO. RD. 300 S.
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168
Practice Address - Country:US
Practice Address - Phone:317-838-7705
Practice Address - Fax:317-838-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities