Provider Demographics
NPI:1851853360
Name:WCFA INC. DBA SYNERGY HOMECARE OF EAST HAVEN
Entity Type:Organization
Organization Name:WCFA INC. DBA SYNERGY HOMECARE OF EAST HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-691-5071
Mailing Address - Street 1:152 SALTONSTALL PKWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2329
Mailing Address - Country:US
Mailing Address - Phone:203-691-5071
Mailing Address - Fax:203-594-8587
Practice Address - Street 1:152 SALTONSTALL PKWY UNIT B
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2329
Practice Address - Country:US
Practice Address - Phone:203-691-5071
Practice Address - Fax:203-594-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTHCA.0001043OtherHOMEMAKER COMPANION REGISTRATION