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General NPI Number Information
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NPI Number | 1942741921
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Entity Type | Organization
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Legal Business Name | ENDEAVOR SWALLOWING SOLUTIONS
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 8826 SHELL ISLAND DR
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4706
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Country | US
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Telephone | 904-403-5910
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Fax |
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Provider Business Mailing Address
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Address Line | 8826 SHELL ISLAND DR
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4706
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Country | US
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Telephone | 904-403-5910
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MISS CATRINA MARIE JOSEPH
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Credential |
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Telephone | 904-403-5910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | SA8479
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SA8479
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License Number State | FL
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