Endeavor Behavioral Health, LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

ENDEAVOR BEHAVIORAL HEALTH, LLC

Practice address

225 Michigan St. NW #3520
Grand Rapids, MI 49501-3520

Phone

(248) 798-0474

NPI assigned

Apr 26, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Beth A BoogholtNPI 1265760128

Title

Chief Executive Officer

Phone

(248) 798-0474

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Beth Ann Boogholt, M.S., BCBA, LLP, LBA

  • Behavior Analyst
  • Grand Rapids, MI
  • NPI 1265760128
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1306334115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MICHIGAN ST. NW #3520",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495013520",
            "telephone_number": "248-798-0474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MICHIGAN ST. NW #3520",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495013520",
            "telephone_number": "248-798-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDEAVOR BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-26",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "BOOGHOLT",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "248-798-0474"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1265760128",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Grand Rapids, MI
• Early Intervention Provider Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.