Provider Demographics
NPI:1053621953
Name:1987LLC D/B/A SYNERGY HOMECARE
Entity type:Organization
Organization Name:1987LLC D/B/A SYNERGY HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-569-3302
Mailing Address - Street 1:108 E WHEEL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8906
Mailing Address - Country:US
Mailing Address - Phone:410-569-3302
Mailing Address - Fax:888-502-9093
Practice Address - Street 1:108 E WHEEL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8906
Practice Address - Country:US
Practice Address - Phone:410-569-3302
Practice Address - Fax:888-502-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3538251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health