Healthcare Provider Details

I. General information

NPI: 1992859326
Provider Name (Legal Business Name): SYCAMORE REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SYCAMORE LN
DANVILLE IN
46122-1474
US

IV. Provider business mailing address

PO BOX 369
DANVILLE IN
46122-0369
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-4715
  • Fax: 317-745-8271
Mailing address:
  • Phone: 317-745-4715
  • Fax: 317-745-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK G COCKRUM
Title or Position: CEO
Credential:
Phone: 317-745-4715