Healthcare Provider Details

I. General information

NPI: 1710693478
Provider Name (Legal Business Name): ENDLESS POSSIBILITIES YOUTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 MCCOOL RD STE 4
VALPARAISO IN
46385-8894
US

IV. Provider business mailing address

786 MCCOOL RD STE 4
VALPARAISO IN
46385-8894
US

V. Phone/Fax

Practice location:
  • Phone: 219-977-3122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ESCOBEDO
Title or Position: CEO
Credential:
Phone: 219-977-3122