Provider Demographics
NPI:1700590635
Name:EVOLVE WELLNESS, INC
Entity Type:Organization
Organization Name:EVOLVE WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-702-4539
Mailing Address - Street 1:4160 TEMESCAL CANYON RD STE 507
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-4629
Mailing Address - Country:US
Mailing Address - Phone:949-702-4539
Mailing Address - Fax:
Practice Address - Street 1:4160 TEMESCAL CANYON RD STE 507
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4629
Practice Address - Country:US
Practice Address - Phone:949-702-4539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)