Healthcare Provider Details

I. General information

NPI: 1174310122
Provider Name (Legal Business Name): SYNERGY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E MCDOWELL RD STE 105
PHOENIX AZ
85006-2607
US

IV. Provider business mailing address

1010 E MCDOWELL RD STE 105
PHOENIX AZ
85006-2607
US

V. Phone/Fax

Practice location:
  • Phone: 833-425-6868
  • Fax: 844-259-0209
Mailing address:
  • Phone: 833-425-6868
  • Fax: 844-259-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUDERAL HALL
Title or Position: PRESIDENT
Credential:
Phone: 678-953-0421