Basic Information
| Provider Information | |||||||||
| NPI: | 1609135763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNTERO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 299 CRAMER CREEK CT | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430172586 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 299 CRAMER CREEK CT | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430172586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148895722 | ||||||||
| FaxNumber: | 6148899335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2012 | ||||||||
| LastUpdateDate: | 09/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | ERWIN RINALDI | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6148895722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 2341719 | 05 | OH | MEDICAID | 403803119-00 | 01 | OH | BWC ID# | OTHER |