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General NPI Number Information
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NPI Number | 1902483043
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Entity Type | Organization
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Legal Business Name | SYNERGY SUPPORT COORDINATION
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 9337 TRAMORE GLEN CT
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4681
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Country | US
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Telephone | 904-699-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 132 AZALEA POINT DR N
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-3663
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Country | US
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Telephone | 904-280-0044
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Fax | 904-212-1223
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CATHY DACQUEL
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Credential |
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Telephone | 904-280-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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