Basic Information
| Provider Information | |||||||||
| NPI: | 1477832772 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYCAMORE SPRINGS, LLC | ||||||||
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| OtherOrganizationName: | SYCAMORE SPRINGS HOSPITAL, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S 5TH ST | ||||||||
| Address2: | SUITE 3830 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871007 | ||||||||
| FaxNumber: | 5025834446 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 PARK EAST BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479050785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657434400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2011 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | WALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4124965959 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | IN | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 201110540A | 05 | IN | MEDICAID |