Sycamore Run, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

145 Issued in WV

Legal business name

SYCAMORE RUN, LLC

Practice address

RR 2 Box 215a
Keyser, WV 26726-9230

Phone

(304) 298-3262

Fax

(304) 298-4100

NPI assigned

Apr 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Brenda Diane Harden

Title

Executive Director

Phone

(304) 298-3262

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073737706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 215A",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "26726",
            "telephone_number": "304-298-3262",
            "fax_number": "304-298-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 215A",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267269230",
            "telephone_number": "304-298-3262",
            "fax_number": "304-298-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYCAMORE RUN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARDEN",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-298-3262",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WV",
            "license": "145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3500002000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suratkal V Shenoy MD PC
• Jennifer Suter
• Gabrielle Rene Sutherland
• Tammy Sue Swaney
• Kara Swingle, RN
• Aida Tafreshi Hosseini, AUD
• Alyssa Dawn Talbert
• Catherine Jayne Taylor
• The Haines Company of Keyser LLC
• Donna Sue Thomas

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Keyser, WV
• Providers in Keyser, WV by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.