Provider Demographics
NPI:1376125369
Name:EVOLUTION CARE SERVICES LLC
Entity Type:Organization
Organization Name:EVOLUTION CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-812-9016
Mailing Address - Street 1:6001 NW 153RD ST STE 154
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2447
Mailing Address - Country:US
Mailing Address - Phone:867-486-9692
Mailing Address - Fax:786-400-2004
Practice Address - Street 1:6625 MIAMI LAKES DR STE 332
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2705
Practice Address - Country:US
Practice Address - Phone:305-779-5180
Practice Address - Fax:786-400-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities