Provider Demographics
NPI:1164414496
Name:SYNERGY HOME CARE NORTHSHORE REGION INC
Entity Type:Organization
Organization Name:SYNERGY HOME CARE NORTHSHORE REGION INC
Other - Org Name:CENTERWELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-429-9040
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 DEREK DR
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5717
Practice Address - Country:US
Practice Address - Phone:985-429-9040
Practice Address - Fax:985-429-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1210251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1403598Medicaid
LA197470Medicare Oscar/Certification