Provider Demographics
NPI:1316588841
Name:EVOLVE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EVOLVE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAGUELOD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:312-278-7138
Mailing Address - Street 1:4535 N MARMORA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3138
Mailing Address - Country:US
Mailing Address - Phone:312-278-7138
Mailing Address - Fax:708-776-7816
Practice Address - Street 1:4535 N MARMORA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3138
Practice Address - Country:US
Practice Address - Phone:312-278-7138
Practice Address - Fax:708-776-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty