Provider Demographics
NPI:1821652892
Name:EVOLVE ADOPTION AND FAMILY SERVICES
Entity Type:Organization
Organization Name:EVOLVE ADOPTION AND FAMILY SERVICES
Other - Org Name:EVOLVE FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-439-2446
Mailing Address - Street 1:5850 OMAHA AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6330
Mailing Address - Country:US
Mailing Address - Phone:651-439-2446
Mailing Address - Fax:651-439-2071
Practice Address - Street 1:5850 OMAHA AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6330
Practice Address - Country:US
Practice Address - Phone:651-439-2446
Practice Address - Fax:651-439-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)