Healthcare Provider Details

I. General information

NPI: 1538072111
Provider Name (Legal Business Name): SYCAMORE RUN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 STATE ROUTE 83
MILLERSBURG OH
44654-9463
US

IV. Provider business mailing address

6180 STATE ROUTE 83
MILLERSBURG OH
44654-9463
US

V. Phone/Fax

Practice location:
  • Phone: 330-674-0015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRANDI KRAFT
Title or Position: OFFICER
Credential:
Phone: 330-674-0015