=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922462761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNERGY HEALTH SYSTEMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2016
-----------------------------------------------------
Last Update Date | 02/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4041 TAYLOR RD SUITE G
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-5536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-487-2803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4041 TAYLOR RD STE H
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-5525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-487-2803
-----------------------------------------------------
Fax | 757-487-2968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DIRECTOR
-----------------------------------------------------
Name | WHITTENEY GUYTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-338-6086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO161470
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 2230
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------