MEDICARE: KYNERGY HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1124363312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYNERGY HOME CARE

Provider Business Mailing Address
First Line	:	4321 ANTIQUE LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1807
Country	:	US
Telephone Number	:	248-432-7276
Fax Number	:	248-254-6678

Provider Business Practice Location Address
First Line	:	4321 ANTIQUE LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1807
Country	:	US
Telephone Number	:	248-432-7276
Fax Number	:	248-254-6678

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. BRIAN COON
Credential	:
Telephone Number	:	248-464-8017

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	12/05/2012

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