Provider Demographics
NPI: | 1013405851 |
---|---|
Name: | ENDEARMENT UNLIMITED, LLC |
Entity Type: | Organization |
Organization Name: | ENDEARMENT UNLIMITED, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | SHAUNTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MCCULLUM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 608-807-0408 |
Mailing Address - Street 1: | 2810 CROSSROADS DR STE 4000 |
Mailing Address - Street 2: | |
Mailing Address - City: | MADISON |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53718-8014 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 608-807-0408 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2810 CROSSROADS DR STE 4000 |
Practice Address - Street 2: | |
Practice Address - City: | MADISON |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53718-8014 |
Practice Address - Country: | US |
Practice Address - Phone: | 608-807-0408 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-04-26 |
Last Update Date: | 2018-04-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 253Z00000X | |
385H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 385H00000X | Respite Care Facility | Respite Care | |
No | 253Z00000X | Agencies | In Home Supportive Care |