=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326621004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNERGY CARE HOSPICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2021
-----------------------------------------------------
Last Update Date | 06/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9550 WARNER AVE STE 250-12
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-593-2312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9550 WARNER AVE STE 250-12
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-593-2312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO/ ADMINISTRATOR DESIGNEE
-----------------------------------------------------
Name | MR. RHANIE SANTIAGO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-389-8379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------