=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770450371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNERGY HEALTHCARE, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 ROLAND AVE
-----------------------------------------------------
City | OWENTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40359-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-757-4353
-----------------------------------------------------
Fax | 859-534-0865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 CAVALIER BLVD STE 120
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41042-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-757-4353
-----------------------------------------------------
Fax | 859-534-0865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING/BILLING
-----------------------------------------------------
Name | SHERRIE LYNN MYERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-757-4353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------