Provider Demographics
NPI:1467127258
Name:EVO HEALTH
Entity Type:Organization
Organization Name:EVO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-340-2726
Mailing Address - Street 1:3766 W ARBY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-5206
Mailing Address - Country:US
Mailing Address - Phone:702-340-2726
Mailing Address - Fax:
Practice Address - Street 1:3766 W ARBY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-5206
Practice Address - Country:US
Practice Address - Phone:702-340-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health