Healthcare Provider Details

I. General information

NPI: 1366892820
Provider Name (Legal Business Name): ENDEAVOR HOME CARE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 2141
ELLSINORE MO
63937-9533
US

IV. Provider business mailing address

RR 2 BOX 2141
ELLSINORE MO
63937-9533
US

V. Phone/Fax

Practice location:
  • Phone: 573-322-0175
  • Fax: 573-322-0176
Mailing address:
  • Phone: 573-322-0175
  • Fax: 573-322-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberM266257807
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLEI KEARBEY
Title or Position: BILLING CLERK
Credential:
Phone: 573-322-0175