Provider Demographics
NPI:1215101381
Name:ENDEAVOR HOUSE NORTH
Entity type:Organization
Organization Name:ENDEAVOR HOUSE NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-264-3824
Mailing Address - Street 1:206 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3384
Mailing Address - Country:US
Mailing Address - Phone:201-991-0035
Mailing Address - Fax:201-991-2066
Practice Address - Street 1:206 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3384
Practice Address - Country:US
Practice Address - Phone:201-991-0035
Practice Address - Fax:201-991-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ200021607261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder