Provider Demographics
NPI:1255090593
Name:ENDEAVOR HCBS LLC
Entity type:Organization
Organization Name:ENDEAVOR HCBS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HCBS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERISA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GIDEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-933-6069
Mailing Address - Street 1:4858 E BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4638
Mailing Address - Country:US
Mailing Address - Phone:480-933-6069
Mailing Address - Fax:480-494-5466
Practice Address - Street 1:4858 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4638
Practice Address - Country:US
Practice Address - Phone:480-933-6069
Practice Address - Fax:480-494-5466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDEAVOR HOME CARE GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-14
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251G00000XAgenciesHospice Care, Community Based
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child