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General NPI Number Information
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NPI Number | 1104292952
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Entity Type | Organization
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Legal Business Name | SYNERGY CARE SERVICES
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 12142 ASTER RD
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City | PHILADELPHIA
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State | PA
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Zip | 19154-1702
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Country | US
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Telephone | 215-570-9661
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Fax |
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Provider Business Mailing Address
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Address Line | 5934 TORRESDALE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-4151
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Country | US
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Telephone | 215-570-9661
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Fax | 215-494-1099
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ADEMOLA OWODUNNI
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Credential | MSW
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Telephone | 215-570-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BH000439
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN289494
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN587494
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License Number State | PA
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