Provider Demographics
NPI:1174945430
Name:COMMUNITY SYNERGY GROUP, INC
Entity type:Organization
Organization Name:COMMUNITY SYNERGY GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-494-2406
Mailing Address - Street 1:299 LORAINE DR
Mailing Address - Street 2:SUITE #1001
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3376
Mailing Address - Country:US
Mailing Address - Phone:407-494-2406
Mailing Address - Fax:866-802-6856
Practice Address - Street 1:299 LORAINE DR
Practice Address - Street 2:SUITE #1001
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3376
Practice Address - Country:US
Practice Address - Phone:407-494-2406
Practice Address - Fax:866-802-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299994275251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016071600Medicaid
FL016071601Medicaid