Provider Demographics
NPI:1487991816
Name:SYCAMORE WELLNESS, LLC
Entity type:Organization
Organization Name:SYCAMORE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TOTH-PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:810-923-7234
Mailing Address - Street 1:3077 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2025
Mailing Address - Country:US
Mailing Address - Phone:810-923-7234
Mailing Address - Fax:
Practice Address - Street 1:3077 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2025
Practice Address - Country:US
Practice Address - Phone:810-923-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty