Provider Demographics
NPI:1104292952
Name:SYNERGY CARE SERVICES
Entity type:Organization
Organization Name:SYNERGY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEMOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWODUNNI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-570-9661
Mailing Address - Street 1:5934 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-4151
Mailing Address - Country:US
Mailing Address - Phone:215-570-9661
Mailing Address - Fax:215-494-1099
Practice Address - Street 1:12142 ASTER RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1702
Practice Address - Country:US
Practice Address - Phone:215-570-9661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000439103K00000X
PAPN289494164W00000X
PARN587494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty