MEDICARE: EARNEST ENDEAVOR THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1245050061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARNEST ENDEAVOR THERAPY LLC

Provider Business Mailing Address
First Line	:	3201 COUNTY ROAD 42 W STE 100
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-7002
Country	:	US
Telephone Number	:	651-302-9281
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 COUNTY ROAD 42 W STE 100
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-7002
Country	:	US
Telephone Number	:	651-302-9281
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YAHYE MOHAMED TAKAL
Credential	:
Telephone Number	:	651-302-9281

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	03/16/2026

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