Provider Demographics
NPI:1629574652
Name:EVOLVE RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:EVOLVE RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-561-7141
Mailing Address - Street 1:7618 MARGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3352
Mailing Address - Country:US
Mailing Address - Phone:954-933-2150
Mailing Address - Fax:954-301-0794
Practice Address - Street 1:7618 MARGATE BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-3352
Practice Address - Country:US
Practice Address - Phone:954-933-2150
Practice Address - Fax:954-301-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1014878324500000X
FL1014879324500000X
FL1014880324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility