Provider Demographics
NPI:1205588423
Name:EVOLVING LIVES, INC
Entity type:Organization
Organization Name:EVOLVING LIVES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIN-CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:786-830-8171
Mailing Address - Street 1:24601 PACKINGHOUSE RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24601 PACKINGHOUSE RD UNIT 2
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3807
Practice Address - Country:US
Practice Address - Phone:786-830-8171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty