Provider Demographics
NPI:1558532465
Name:SYCAMORE HEALTHCARE ASSOCIATES INC.
Entity Type:Organization
Organization Name:SYCAMORE HEALTHCARE ASSOCIATES INC.
Other - Org Name:LEGACY POST ACUTE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:NHAP
Authorized Official - Phone:510-593-3113
Mailing Address - Street 1:1790 MUIR RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4718
Mailing Address - Country:US
Mailing Address - Phone:925-228-8383
Mailing Address - Fax:510-922-8105
Practice Address - Street 1:1790 MUIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4718
Practice Address - Country:US
Practice Address - Phone:925-228-8383
Practice Address - Fax:925-335-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000173314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558532465Medicaid