NPIMap

Organization Active NPI

Evolve Residential, LLC

  • Substance Abuse Rehabilitation Facility
  • Glen Burnie, MD
National Provider Identifier
1124626296
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
EVOLVE RESIDENTIAL, LLC
Practice address
390 Washington Ave
Glen Burnie, MD 21060-8712
Phone
(410) 456-7404
NPI assigned
Oct 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Authorized official

Name
Sara Burden
Title
Executive Director
Phone
(410) 456-7404

Specialties & licenses 1

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

Addresses

Primary practice location

390 Washington Ave
Glen Burnie, MD 21060-8712

Mailing address

390 Washington Ave
Glen Burnie, MD 21060-8712

National Provider Directory

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

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": "1602460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602460800000",
    "number": "1124626296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 WASHINGTON AVE",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210608712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 WASHINGTON AVE",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210608712",
            "telephone_number": "410-456-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE RESIDENTIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-12",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A",
        "authorized_official_last_name": "BURDEN",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "410-456-7404"
    },
    "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 Oct 12, 2020; 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.