Provider Demographics
NPI:1548278518
Name:SYNERGY HOME HEALTH & WOUND CARE SUPPLY, INC.
Entity type:Organization
Organization Name:SYNERGY HOME HEALTH & WOUND CARE SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O'HARA
Authorized Official - Last Name:FORGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-565-7095
Mailing Address - Street 1:3949 CLAIREMONT DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5513
Mailing Address - Country:US
Mailing Address - Phone:858-565-7095
Mailing Address - Fax:877-261-4583
Practice Address - Street 1:3949 CLAIREMONT DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5513
Practice Address - Country:US
Practice Address - Phone:858-565-7095
Practice Address - Fax:877-261-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5450720001Medicare NSC