Provider Demographics
NPI:1831554609
Name:ENDEAVORS ADULT DEVELOPMENT CENTER
Entity type:Organization
Organization Name:ENDEAVORS ADULT DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-485-8764
Mailing Address - Street 1:101 150TH ST
Mailing Address - Street 2:
Mailing Address - City:BALSAM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54810-8011
Mailing Address - Country:US
Mailing Address - Phone:715-485-8764
Mailing Address - Fax:715-485-8740
Practice Address - Street 1:101 150TH ST
Practice Address - Street 2:
Practice Address - City:BALSAM LAKE
Practice Address - State:WI
Practice Address - Zip Code:54810-8011
Practice Address - Country:US
Practice Address - Phone:715-485-8764
Practice Address - Fax:715-485-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care