Provider Demographics
NPI:1356981955
Name:ENDEAVOR HEALTH CENTER LLC
Entity type:Organization
Organization Name:ENDEAVOR HEALTH CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-613-4716
Mailing Address - Street 1:155 FOUNTAINS WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-1144
Mailing Address - Country:US
Mailing Address - Phone:904-342-5455
Mailing Address - Fax:
Practice Address - Street 1:155 FOUNTAINS WAY STE 6
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-1144
Practice Address - Country:US
Practice Address - Phone:904-342-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDEAVOR HEALTH CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty