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General NPI Number Information
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NPI Number | 1992355911
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Entity Type | Organization
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Legal Business Name | EVOLUTION SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 9344 E ZAYANTE RD
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City | FELTON
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State | CA
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Zip | 95018-9017
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Country | US
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Telephone | 831-713-7869
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 657
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City | SANTA CRUZ
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State | CA
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Zip | 95061-0657
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Country | US
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Telephone | 831-713-7869
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Fax | 831-426-6891
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SCOTT BEESLEY
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Credential |
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Telephone | 831-713-7869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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