Provider Demographics
NPI:1902483043
Name:SYNERGY SUPPORT COORDINATION
Entity Type:Organization
Organization Name:SYNERGY SUPPORT COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DACQUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-280-0044
Mailing Address - Street 1:132 AZALEA POINT DR N
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3663
Mailing Address - Country:US
Mailing Address - Phone:904-280-0044
Mailing Address - Fax:904-212-1223
Practice Address - Street 1:9337 TRAMORE GLEN CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4681
Practice Address - Country:US
Practice Address - Phone:904-699-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management