Healthcare Provider Details

I. General information

NPI: 1942741921
Provider Name (Legal Business Name): ENDEAVOR SWALLOWING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8826 SHELL ISLAND DR
JACKSONVILLE FL
32216-4706
US

IV. Provider business mailing address

8826 SHELL ISLAND DR
JACKSONVILLE FL
32216-4706
US

V. Phone/Fax

Practice location:
  • Phone: 904-403-5910
  • Fax:
Mailing address:
  • Phone: 904-403-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSA8479
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberSA8479
License Number StateFL

VIII. Authorized Official

Name: MISS CATRINA MARIE JOSEPH
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 904-403-5910