Provider Demographics
NPI:1114774296
Name:ENDEAVOR MENTAL HEALTHCARE AND MEDICAL SERVICES LTD
Entity type:Organization
Organization Name:ENDEAVOR MENTAL HEALTHCARE AND MEDICAL SERVICES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-405-8076
Mailing Address - Street 1:10611 SOUTH LOWE
Mailing Address - Street 2:HOUSE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628
Mailing Address - Country:US
Mailing Address - Phone:773-405-8076
Mailing Address - Fax:
Practice Address - Street 1:10336 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2407
Practice Address - Country:US
Practice Address - Phone:773-405-8076
Practice Address - Fax:605-309-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty