Provider Demographics
NPI:1356060842
Name:EVOLVE FAMILY LIFE SERVICES LLC
Entity type:Organization
Organization Name:EVOLVE FAMILY LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-470-4636
Mailing Address - Street 1:9314 NORMANDIE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3866
Mailing Address - Country:US
Mailing Address - Phone:318-562-3596
Mailing Address - Fax:318-626-7179
Practice Address - Street 1:1916 RINGGOLD AVE
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-9089
Practice Address - Country:US
Practice Address - Phone:318-562-3596
Practice Address - Fax:318-626-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No174200000XOther Service ProvidersMeals
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No343800000XTransportation ServicesSecured Medical Transport (VAN)