Provider Demographics
NPI: | 1225290224 |
---|---|
Name: | RLJ ENTERPRISES INC |
Entity Type: | Organization |
Organization Name: | RLJ ENTERPRISES INC |
Other - Org Name: | SYNERGY HOMECARE OF GOODYEAR |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RAY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 623-935-9961 |
Mailing Address - Street 1: | 2990 N LITCHFIELD RD |
Mailing Address - Street 2: | SUITE 106 |
Mailing Address - City: | GOODYEAR |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85395-7800 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 623-935-9961 |
Mailing Address - Fax: | 623-935-9976 |
Practice Address - Street 1: | 2990 N LITCHFIELD RD |
Practice Address - Street 2: | SUITE 106 |
Practice Address - City: | GOODYEAR |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85395-7800 |
Practice Address - Country: | US |
Practice Address - Phone: | 623-935-9961 |
Practice Address - Fax: | 623-935-9976 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-30 |
Last Update Date: | 2008-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |