Provider Demographics
NPI:1154962835
Name:SYCAMORESPRING HEALTH CARE AND REHABILITATION LLC
Entity type:Organization
Organization Name:SYCAMORESPRING HEALTH CARE AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:513-707-1537
Mailing Address - Street 1:390 WARDS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6969
Mailing Address - Country:US
Mailing Address - Phone:513-707-1546
Mailing Address - Fax:513-248-3772
Practice Address - Street 1:2164 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3627
Practice Address - Country:US
Practice Address - Phone:513-707-1546
Practice Address - Fax:513-248-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0456988Medicaid