Provider Demographics
NPI:1740411271
Name:SYNERGY ALLIANCE LLC
Entity Type:Organization
Organization Name:SYNERGY ALLIANCE LLC
Other - Org Name:MY ROYAL PALACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:972-897-0017
Mailing Address - Street 1:315 E WALL ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5402
Mailing Address - Country:US
Mailing Address - Phone:972-283-7277
Mailing Address - Fax:
Practice Address - Street 1:315 E WALL ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5402
Practice Address - Country:US
Practice Address - Phone:972-283-7277
Practice Address - Fax:682-323-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities