Healthcare Provider Details

I. General information

NPI: 1053621953
Provider Name (Legal Business Name): 1987LLC D/B/A SYNERGY HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E WHEEL RD SUITE 101
BEL AIR MD
21015-8906
US

IV. Provider business mailing address

108 E WHEEL RD SUITE 101
BEL AIR MD
21015-8906
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-3302
  • Fax: 888-502-9093
Mailing address:
  • Phone: 410-569-3302
  • Fax: 888-502-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR3538
License Number StateMD

VIII. Authorized Official

Name: MR. MARK S DECKER
Title or Position: MANAGING MEMBER
Credential:
Phone: 410-569-3302