Provider Demographics
NPI:1538297262
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 1:465 S MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-2161
Mailing Address - Country:US
Mailing Address - Phone:765-342-2476
Mailing Address - Fax:
Practice Address - Street 1:465 S MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-2161
Practice Address - Country:US
Practice Address - Phone:765-342-2476
Practice Address - Fax:
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