Provider Demographics
NPI:1366892820
Name:ENDEAVOR HOME CARE LLP
Entity type:Organization
Organization Name:ENDEAVOR HOME CARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:KELLEI
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-322-0175
Mailing Address - Street 1:RR 2 BOX 2141
Mailing Address - Street 2:
Mailing Address - City:ELLSINORE
Mailing Address - State:MO
Mailing Address - Zip Code:63937-9533
Mailing Address - Country:US
Mailing Address - Phone:573-322-0175
Mailing Address - Fax:573-322-0176
Practice Address - Street 1:RR 2 BOX 2141
Practice Address - Street 2:
Practice Address - City:ELLSINORE
Practice Address - State:MO
Practice Address - Zip Code:63937-9533
Practice Address - Country:US
Practice Address - Phone:573-322-0175
Practice Address - Fax:573-322-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOM266257807302R00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM266257807Medicaid