Organization
ENDEAVOR BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETH A BOOGHOLT (CHIEF EXECUTIVE OFFICER)
(248) 798-0474
Entity
Organization
Contact information
Practice address
225 MICHIGAN ST. NW #3520, GRAND RAPIDS, MI 49501-3520
(248) 798-0474
Mailing address
225 MICHIGAN ST. NW #3520, GRAND RAPIDS, MI 49501-3520
(248) 798-0474
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265760128
INDIVIDUAL NPI
—
Enumeration date
04/26/2018
Last updated
04/26/2018
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