Basic Information
| Provider Information | |||||||||
| NPI: | 1134665029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERGY SERVICE NETWORK AND AFFILIATE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29155 NORTHWESTERN HWY UNIT 781 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137845560 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14954 MEYERS RD | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482274088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137845560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2017 | ||||||||
| LastUpdateDate: | 01/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | SAUNDERS-DAVENPORT | ||||||||
| AuthorizedOfficialFirstName: | KHADISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3137845560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.