Provider Demographics
NPI:1639826613
Name:SYCAMORE GROVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SYCAMORE GROVE HEALTHCARE LLC
Other - Org Name:ARDENT HOSPICE OF FRESNO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:2040 N WINERY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4814
Mailing Address - Country:US
Mailing Address - Phone:595-408-5945
Mailing Address - Fax:
Practice Address - Street 1:2040 N WINERY AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-4814
Practice Address - Country:US
Practice Address - Phone:595-408-5945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based