MEDICARE: INTEGRATED SYCAMORE GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1417431305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED SYCAMORE GROUP LLC

Provider Business Mailing Address
First Line	:	22101 GRAND CORNER DR APT 10208
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-5948
Country	:	US
Telephone Number	:	832-335-4098
Fax Number	:

Provider Business Practice Location Address
First Line	:	8315 SIERRA HILL CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5147
Country	:	US
Telephone Number	:	832-335-4098
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JUDE UCHEWUAKOR
Credential	:
Telephone Number	:	832-335-4098

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/02/2025

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