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General NPI Number Information
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NPI Number | 1205426053
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Entity Type | Organization
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Legal Business Name | SYCAMORE INTEGRATED HEALTH LLC
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 1350 E MCKELLIPS RD STE 5
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City | MESA
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State | AZ
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Zip | 85203-2739
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Country | US
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Telephone | 480-833-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 3546 E WINDMERE DR
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City | PHOENIX
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State | AZ
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Zip | 85048-7211
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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 | ADMINISTRATOR
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Name | IMMA NZOMO
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Credential | APRN
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Telephone | 480-608-4877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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