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General NPI Number Information
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NPI Number | 1184117152
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Entity Type | Organization
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Legal Business Name | THE SYCAMORE
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 1511 S VAN BUREN ST
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City | AMARILLO
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State | TX
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Zip | 79101-4129
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Country | US
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Telephone | 806-337-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 S VAN BUREN ST
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City | AMARILLO
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State | TX
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Zip | 79101-4129
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | ROBERT SMITH
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Credential |
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Telephone | 806-337-4144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 104442
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License Number State | TX
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