Organization Name: | SYCAMORE RUN, LLC |
NPI Number: | 1073737706 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRENDA DIANE HARDEN (EXECUTIVE DIRECTOR) |
Mailing Address: | Rr 2 Box 215a Keyser |
State: | WV US |
Postal Code: | 267269230 |
Phone Number: | 3042983262 |
Fax Number: | 3042984100 |
NPI Enumeration Date: | 04/12/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 145 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |