Healthcare Provider Details

I. General information

NPI: 1770177396
Provider Name (Legal Business Name): ENDLESS ABILITIES FOR CHILDREN WITH DISABILITIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E SUMMERLIN ST
BARTOW FL
33830-5010
US

IV. Provider business mailing address

PO BOX 1712
BARTOW FL
33831-1712
US

V. Phone/Fax

Practice location:
  • Phone: 863-205-1624
  • Fax:
Mailing address:
  • Phone: 863-205-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RESHEKA HARRIS
Title or Position: CEO
Credential:
Phone: 863-205-1624