Provider Demographics
NPI:1346969318
Name:THE EVOLVE EFFECT
Entity Type:Organization
Organization Name:THE EVOLVE EFFECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-906-6774
Mailing Address - Street 1:3115 S CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2641
Mailing Address - Country:US
Mailing Address - Phone:909-906-6774
Mailing Address - Fax:
Practice Address - Street 1:920 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3530
Practice Address - Country:US
Practice Address - Phone:909-906-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty