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General NPI Number Information
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NPI Number | 1730590282
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Entity Type | Organization
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Legal Business Name | EVOLUTION OF LIFE, LLC
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Dates
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Enumeration Date | 05/17/2014
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Last Update Date | 05/17/2014
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Provider Practice Location Address
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Address Line | 6074 SECRET ISLAND DR
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City | LAS VEGAS
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State | NV
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Zip | 89139-6250
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Country | US
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Telephone | 702-528-8968
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 N HWY 360 APT 521
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-8715
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Country | US
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Telephone | 702-528-8968
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Fax |
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Authorized Official
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Title or Position | OWNER/CFO
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Name | MR. JOSEPH ASHLEY WATKINS
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Credential |
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Telephone | 702-528-8968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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