MEDICARE: EVOLVE GROWTH INITIATIVES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	323P00000X	Psychiatric Residential Treatment Facility
3	3245S0500X	Children's Substance Abuse Rehabilitation Facility
4	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1033639307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE GROWTH INITIATIVES LLC

Provider Business Mailing Address
First Line	:	300 N PACIFIC COAST HWY STE 2060
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-4479
Country	:	US
Telephone Number	:	424-281-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4810 AZUCENA RD
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-4040
Country	:	US
Telephone Number	:	424-281-5000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARON GITTLESON
Credential	:
Telephone Number	:	718-931-9700

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	03/06/2024

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