Provider Demographics
NPI:1710438080
Name:ENDLESS ABILITIES FOR CHILDREN WITH DISABILITIES INC
Entity Type:Organization
Organization Name:ENDLESS ABILITIES FOR CHILDREN WITH DISABILITIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RESHEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-205-1624
Mailing Address - Street 1:PO BOX 1712
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-1712
Mailing Address - Country:US
Mailing Address - Phone:863-205-1624
Mailing Address - Fax:
Practice Address - Street 1:905 E SUMMERLIN ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-5010
Practice Address - Country:US
Practice Address - Phone:863-205-1624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
FL251E00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024998400Medicaid