Provider Demographics
NPI:1992859326
Name:SYCAMORE REHABILITATION SERVICES
Entity Type:Organization
Organization Name:SYCAMORE REHABILITATION SERVICES
Other - Org Name:SYCAMORE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:COCKRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-745-4715
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-0369
Mailing Address - Country:US
Mailing Address - Phone:317-745-4715
Mailing Address - Fax:317-745-8271
Practice Address - Street 1:1001 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1474
Practice Address - Country:US
Practice Address - Phone:317-745-4715
Practice Address - Fax:317-745-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities