Healthcare Provider Details

I. General information

NPI: 1326745472
Provider Name (Legal Business Name): EVOLVE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 JACKSON ST
AUGUSTA MO
63332-1721
US

IV. Provider business mailing address

165 JACKSON ST
AUGUSTA MO
63332-1721
US

V. Phone/Fax

Practice location:
  • Phone: 314-974-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: HAYLEY MARIE JEHLING
Title or Position: OWNER/MEMBER
Credential:
Phone: 314-974-0200