Healthcare Provider Details

I. General information

NPI: 1831554609
Provider Name (Legal Business Name): ENDEAVORS ADULT DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 150TH ST
BALSAM LAKE WI
54810-8011
US

IV. Provider business mailing address

101 150TH ST
BALSAM LAKE WI
54810-8011
US

V. Phone/Fax

Practice location:
  • Phone: 715-485-8764
  • Fax: 715-485-8740
Mailing address:
  • Phone: 715-485-8764
  • Fax: 715-485-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN S CLARK
Title or Position: DIRECTOR
Credential:
Phone: 715-485-8764