Healthcare Provider Details

I. General information

NPI: 1144147331
Provider Name (Legal Business Name): SYCAMORE GLEN SL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 N SULLIVAN RD STE 100-37
SPOKANE VALLEY WA
99216-5198
US

IV. Provider business mailing address

PO BOX 272
SPOKANE VALLEY WA
99037-0272
US

V. Phone/Fax

Practice location:
  • Phone: 509-655-0121
  • Fax: 509-463-0893
Mailing address:
  • Phone: 509-655-0121
  • Fax: 509-463-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE STEVENS
Title or Position: DIRECTOR
Credential: RN
Phone: 509-332-9152