Healthcare Provider Details

I. General information

NPI: 1831005396
Provider Name (Legal Business Name): EVOLVE CARE MOBILITY & HEALTH SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11907 229TH ST
CAMBRIA HEIGHTS NY
11411-2205
US

IV. Provider business mailing address

11907 229TH ST
CAMBRIA HEIGHTS NY
11411-2205
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-4423
  • Fax: 718-744-2930
Mailing address:
  • Phone: 718-283-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: JIANNA FORD
Title or Position: OWNER
Credential:
Phone: 718-283-4423