Healthcare Provider Details

I. General information

NPI: 1629574652
Provider Name (Legal Business Name): EVOLVE RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 MARGATE BLVD
MARGATE FL
33063-3352
US

IV. Provider business mailing address

7618 MARGATE BLVD
MARGATE FL
33063-3352
US

V. Phone/Fax

Practice location:
  • Phone: 954-933-2150
  • Fax: 954-301-0794
Mailing address:
  • Phone: 954-933-2150
  • Fax: 954-301-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1014879
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1014880
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1014878
License Number StateFL

VIII. Authorized Official

Name: JANIE WATERS
Title or Position: BUSINESS ADMINISTRATION
Credential:
Phone: 561-561-7141