Healthcare Provider Details

I. General information

NPI: 1407523244
Provider Name (Legal Business Name): EVOLVE RECOVERY CENTER AT MILLBURY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2021
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MAIN ST STE 300
MILLBURY MA
01527-2005
US

IV. Provider business mailing address

PO BOX 27035
NEWARK NJ
07101-6735
US

V. Phone/Fax

Practice location:
  • Phone: 508-876-3223
  • Fax: 508-876-3224
Mailing address:
  • Phone: 508-876-3223
  • Fax: 508-876-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CHELALES
Title or Position: VP OF COMPLIANCE
Credential:
Phone: 646-285-4035