Provider Demographics
NPI:1184061517
Name:COMMUNITY SYNERGY GROUP, INC.
Entity type:Organization
Organization Name:COMMUNITY SYNERGY GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-464-0008
Mailing Address - Street 1:540 N STATE ROAD 434 STE 67
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2140
Mailing Address - Country:US
Mailing Address - Phone:407-464-0008
Mailing Address - Fax:866-802-6856
Practice Address - Street 1:540 N STATE ROAD 434 STE 67
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2140
Practice Address - Country:US
Practice Address - Phone:407-464-0008
Practice Address - Fax:866-802-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233041253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008112500Medicaid