Provider Demographics
NPI:1174186381
Name:SYNERGY HOMECARE OF NW VA LLC
Entity Type:Organization
Organization Name:SYNERGY HOMECARE OF NW VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-636-0038
Mailing Address - Street 1:1105 N ROYAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3525
Mailing Address - Country:US
Mailing Address - Phone:540-636-0038
Mailing Address - Fax:540-551-3587
Practice Address - Street 1:1105 N ROYAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3525
Practice Address - Country:US
Practice Address - Phone:540-636-0038
Practice Address - Fax:540-551-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-1620OtherVIRGINIA DEPT OF HEALTH HOME CARE LICENSE