Provider Demographics
NPI:1306037916
Name:SYNANON INC
Entity Type:Organization
Organization Name:SYNANON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGPRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-847-5323
Mailing Address - Street 1:1091 S BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2607
Mailing Address - Country:US
Mailing Address - Phone:616-604-0096
Mailing Address - Fax:
Practice Address - Street 1:1091 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2607
Practice Address - Country:US
Practice Address - Phone:616-604-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G1123OtherBCBS CNP GROUP