Provider Demographics
NPI:1407523244
Name:EVOLVE RECOVERY CENTER AT MILLBURY LLC
Entity Type:Organization
Organization Name:EVOLVE RECOVERY CENTER AT MILLBURY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-285-4035
Mailing Address - Street 1:PO BOX 27035
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-6735
Mailing Address - Country:US
Mailing Address - Phone:508-876-3223
Mailing Address - Fax:508-876-3224
Practice Address - Street 1:29 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2005
Practice Address - Country:US
Practice Address - Phone:508-876-3223
Practice Address - Fax:508-876-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-29
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility