Provider Demographics
NPI:1033639307
Name:EVOLVE GROWTH INITIATIVES LLC
Entity Type:Organization
Organization Name:EVOLVE GROWTH INITIATIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GITTLESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-931-9700
Mailing Address - Street 1:300 N PACIFIC COAST HWY STE 2060
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4479
Mailing Address - Country:US
Mailing Address - Phone:424-281-5000
Mailing Address - Fax:
Practice Address - Street 1:4810 AZUCENA RD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4040
Practice Address - Country:US
Practice Address - Phone:424-281-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children