Healthcare Provider Details

I. General information

NPI: 1700713930
Provider Name (Legal Business Name): ENDEAVOR DLW FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10336 S WESTERN AVE
CHICAGO IL
60643-2407
US

IV. Provider business mailing address

10611 S LOWE AVE
CHICAGO IL
60628-2311
US

V. Phone/Fax

Practice location:
  • Phone: 708-581-8031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA VOWAL
Title or Position: OWNER
Credential:
Phone: 708-581-8031