Provider Demographics
NPI:1770348294
Name:EVELAKE, INC.
Entity type:Organization
Organization Name:EVELAKE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ILHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-200-7058
Mailing Address - Street 1:8030 OLD CEDAR AVE S STE 110
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1214
Mailing Address - Country:US
Mailing Address - Phone:612-200-7058
Mailing Address - Fax:952-426-4935
Practice Address - Street 1:8030 OLD CEDAR AVE S STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1214
Practice Address - Country:US
Practice Address - Phone:612-200-7058
Practice Address - Fax:952-426-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency