Provider Demographics
NPI:1063406676
Name:THE SYNERGY FOUNDATION, INC.
Entity type:Organization
Organization Name:THE SYNERGY FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERLESKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-332-2227
Mailing Address - Street 1:P.O. BOX 16217
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38186
Mailing Address - Country:US
Mailing Address - Phone:901-332-2227
Mailing Address - Fax:901-332-0477
Practice Address - Street 1:2305 AIRPORT INTERCHANGE AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132
Practice Address - Country:US
Practice Address - Phone:901-332-2227
Practice Address - Fax:901-332-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN324500000X
TNL000000006634324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506838Medicaid