MEDICARE: LIFE EVOLVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1437034089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE EVOLVE LLC

Provider Business Mailing Address
First Line	:	7277 HANOVER GREEN DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-1764
Country	:	US
Telephone Number	:	804-789-8747
Fax Number	:	804-789-8867

Provider Business Practice Location Address
First Line	:	7277 HANOVER GREEN DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-1764
Country	:	US
Telephone Number	:	804-437-0237
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAWN JOHNSON
Credential	:
Telephone Number	:	804-437-0237

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	02/18/2026

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Directions to “LIFE EVOLVE LLC ” Practice Location

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