=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932523842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDSLEY HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2014
-----------------------------------------------------
Last Update Date | 02/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 BURKARTH RD SUITE C-LOWER LEVEL
-----------------------------------------------------
City | WARRENSBURG
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64093-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-362-1412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 BURKARTH RD SUITE C-LOWER LEVEL
-----------------------------------------------------
City | WARRENSBURG
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64093-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-362-1412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/CHIEF EXECUTIVE
-----------------------------------------------------
Name | MR. ERIC JOHN ENDSLEY
-----------------------------------------------------
Credential | MHPM, NHA
-----------------------------------------------------
Telephone | 660-362-1413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------