Healthcare Provider Details

I. General information

NPI: 1184084527
Provider Name (Legal Business Name): SYNERGY EMPOWERMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2016
Last Update Date: 02/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 S VALLEY VIEW BLVD
LAS VEGAS NV
89107-4416
US

IV. Provider business mailing address

928 S VALLEY VIEW BLVD
LAS VEGAS NV
89107-4416
US

V. Phone/Fax

Practice location:
  • Phone: 504-339-5668
  • Fax:
Mailing address:
  • Phone: 504-339-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY T ROGERS
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 504-339-5668