NPIMap

Organization Active NPI

Evolve Residential LLC

  • Substance Abuse Rehabilitation Facility
  • Glen Burnie, MD
National Provider Identifier
1043957137
Registry record updated Jul 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
EVOLVE RESIDENTIAL LLC
Practice address
6305 Carolina Ave
Glen Burnie, MD 21061-1601
Phone
(443) 548-3733
NPI assigned
May 19, 2022
Organization subpart
Yes
Parent organization
EVOLVE RESIDENTIAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessie Costley
Title
Licensing & Credentialing Specialis
Phone
(443) 548-3733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

6305 Carolina Ave
Glen Burnie, MD 21061-1601

Mailing address

2528 Mountain Rd Ste 204
Pasadena, MD 21122-7204
Phone (443) 548-3733

National Provider Directory

National Provider Directory
Tax ID family
Evolve Residential LLC9 organizations share this tax ID, including this one
Part of
Evolve Residential LLC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752364800000",
    "number": "1043957137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 MOUNTAIN RD STE 204",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211227204",
            "telephone_number": "443-548-3733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6305 CAROLINA AVE",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210611601",
            "telephone_number": "443-548-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE RESIDENTIAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVOLVE RESIDENTIAL LLC",
        "enumeration_date": "2022-05-19",
        "last_updated": "2025-07-13",
        "certification_date": "2025-07-13",
        "status": "A",
        "authorized_official_last_name": "COSTLEY",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "LICENSING & CREDENTIALING SPECIALIS",
        "authorized_official_telephone_number": "443-548-3733"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.