Provider Demographics
NPI:1578106381
Name:ENDEARMENT, LLC.
Entity Type:Organization
Organization Name:ENDEARMENT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VISSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-920-8925
Mailing Address - Street 1:107 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5001
Mailing Address - Country:US
Mailing Address - Phone:443-350-9728
Mailing Address - Fax:
Practice Address - Street 1:107 WALNUT LN
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5001
Practice Address - Country:US
Practice Address - Phone:443-350-9728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5647011P0001Medicaid