Provider Demographics
NPI:1952849283
Name:MILE POST 53, LLC
Entity Type:Organization
Organization Name:MILE POST 53, LLC
Other - Org Name:SYNERGY HOMECARE OF CENTRAL VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ENDERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-299-3479
Mailing Address - Street 1:11159 AIR PARK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-3500
Mailing Address - Country:US
Mailing Address - Phone:804-299-3479
Mailing Address - Fax:804-299-4016
Practice Address - Street 1:11159 AIR PARK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-3500
Practice Address - Country:US
Practice Address - Phone:804-299-3479
Practice Address - Fax:804-299-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171428253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care