Provider Demographics
NPI:1417595463
Name:UBU SYNERGY SUPPORT LLC
Entity Type:Organization
Organization Name:UBU SYNERGY SUPPORT LLC
Other - Org Name:UBU SYNERGY SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-300-6550
Mailing Address - Street 1:8821 BRANSON DR
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-3524
Mailing Address - Country:US
Mailing Address - Phone:651-230-6774
Mailing Address - Fax:651-305-9395
Practice Address - Street 1:5814 BLACKSHIRE PATH
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1618
Practice Address - Country:US
Practice Address - Phone:651-300-6550
Practice Address - Fax:651-305-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health