Organization
SYCAMORE RUN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA DIANE HARDEN (EXECUTIVE DIRECTOR)
(304) 298-3262
Entity
Organization
Contact information
Practice address
RR 2 BOX 215A, KEYSER, WV 26726-9230
(304) 298-3262
(304) 298-4100
Mailing address
RR 2 BOX 215A, KEYSER, WV 26726
(304) 298-3262
(304) 298-4100
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
145
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3500002000
—
WV
Enumeration date
04/12/2007
Last updated
08/22/2020
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