Provider Demographics
NPI:1972218071
Name:SYCAMORE OASIS CORPORATION
Entity Type:Organization
Organization Name:SYCAMORE OASIS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOSIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:OMISORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-699-7894
Mailing Address - Street 1:1552 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6044
Mailing Address - Country:US
Mailing Address - Phone:773-699-7894
Mailing Address - Fax:773-609-8856
Practice Address - Street 1:1552 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6044
Practice Address - Country:US
Practice Address - Phone:177-369-9789
Practice Address - Fax:773-609-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care