=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104431147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVOLVE HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2020
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30851 AGOURA RD STE 310
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-4312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-230-4215
-----------------------------------------------------
Fax | 818-337-2445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30851 AGOURA RD STE 310
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-4312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-230-4215
-----------------------------------------------------
Fax | 818-337-2445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NOGOL PEDRAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-230-4215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------