Provider Demographics
NPI:1346388444
Name:ENDREDY ENTERPRISES, LLC
Entity Type:Organization
Organization Name:ENDREDY ENTERPRISES, LLC
Other - Org Name:SYNERGY HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ENDREDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-377-6770
Mailing Address - Street 1:1855 W BASELINE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9010
Mailing Address - Country:US
Mailing Address - Phone:480-377-6770
Mailing Address - Fax:480-377-6763
Practice Address - Street 1:1855 W BASELINE RD STE 202
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9010
Practice Address - Country:US
Practice Address - Phone:480-377-6770
Practice Address - Fax:480-377-6763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ967292Medicaid