Provider Demographics
NPI:1053576595
Name:SYCAMORE REHABILITATION SERVICES
Entity type:Organization
Organization Name:SYCAMORE REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
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:
Practice Address - Street 1:465 S MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-2162
Practice Address - Country:US
Practice Address - Phone:317-745-4715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)