NPI 1154527810

Grand Victorian of Sycamore, LLC

Organisation Point of Service Sycamore, IL

Practice location

Address: 1440 Somonauk St, Sycamore, IL 60178-2916
Phone: (815) 895-1900
Fax: (815) 895-1901
Mailing address: 78 Centennial Loop, Eugene, OR 97401-7900

Authorised official

Name: John Holtz
Title: Controller
Phone: (541) 747-3373

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X

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Registry record

NPI: 1154527810
Entity type: Organization
NPI issued: 21 Jun 2007
Record last updated: 13 May 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.