Synergy Recovery

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL-097-003 Issued in NC

Legal business name

SYNERGY RECOVERY

Practice address

118 Peace St
North Wilkesboro, NC 28659-4519

Phone

(336) 667-7191

Fax

(336) 667-6859

NPI assigned

Sep 14, 2006

Last updated

Sep 1, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carl Yates Spake, MA,CCS,CSAC

Title

Director

Phone

(336) 667-7191

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1922103787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286970026",
            "telephone_number": "336-667-7191",
            "fax_number": "336-667-6859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 PEACE ST",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286594519",
            "telephone_number": "336-667-7191",
            "fax_number": "336-667-6859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "SPAKE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "YATES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-667-7191",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA,CCS,CSAC"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-097-003",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL097003",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301254",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.