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General NPI Number Information
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NPI Number | 1760803639
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Entity Type | Organization
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Legal Business Name | EVOLVE HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 126 PINE ST
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City | FOREST CITY
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State | NC
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Zip | 28043-4587
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Country | US
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Telephone | 828-248-4369
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Fax |
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Provider Business Mailing Address
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Address Line | 614 ELDORADO ST
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City | TROY
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State | NC
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Zip | 27371-2628
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Country | US
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Telephone | 910-576-0691
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HILARY BRIGGS PUZAK
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Credential |
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Telephone | 910-576-0691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 081-099
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License Number State | NC
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