Provider Demographics
NPI:1942741921
Name:ENDEAVOR SWALLOWING SOLUTIONS
Entity Type:Organization
Organization Name:ENDEAVOR SWALLOWING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CATRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-403-5910
Mailing Address - Street 1:8826 SHELL ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4706
Mailing Address - Country:US
Mailing Address - Phone:904-403-5910
Mailing Address - Fax:
Practice Address - Street 1:8826 SHELL ISLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4706
Practice Address - Country:US
Practice Address - Phone:904-403-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8479314000000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities