Provider Demographics
NPI:1659677839
Name:SYCAMORE REHAB SERVICES/HENDRICKS CO. ARC, INC.
Entity Type:Organization
Organization Name:SYCAMORE REHAB SERVICES/HENDRICKS CO. ARC, INC.
Other - Org Name:SYCAMORE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-745-4715
Mailing Address - Street 1:1001 SYCAMORE LN
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1474
Mailing Address - Country:US
Mailing Address - Phone:317-745-4715
Mailing Address - Fax:317-745-8271
Practice Address - Street 1:10 W HANNA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-5102
Practice Address - Country:US
Practice Address - Phone:317-664-7076
Practice Address - Fax:317-786-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107900Medicaid