Provider Demographics
NPI:1275298127
Name:SYNERGY HOMECARE OF PROSPER
Entity Type:Organization
Organization Name:SYNERGY HOMECARE OF PROSPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:GREGORIOS
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-597-6564
Mailing Address - Street 1:407 W ELDORADO PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5281
Mailing Address - Country:US
Mailing Address - Phone:214-629-4042
Mailing Address - Fax:
Practice Address - Street 1:407 W ELDORADO PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5281
Practice Address - Country:US
Practice Address - Phone:214-629-4042
Practice Address - Fax:469-498-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24395430OtherVA