Provider Demographics
NPI:1407362106
Name:SYNERGY OUTREACH SERVICES
Entity Type:Organization
Organization Name:SYNERGY OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-659-3060
Mailing Address - Street 1:314 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2457
Mailing Address - Country:US
Mailing Address - Phone:414-659-3060
Mailing Address - Fax:414-386-7913
Practice Address - Street 1:314 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2457
Practice Address - Country:US
Practice Address - Phone:414-659-3060
Practice Address - Fax:414-386-7913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:XAVIER HOME HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-18
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100034505Medicaid