Evolve Life Centers Iop LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

EVOLVE LIFE CENTERS IOP LLC

Practice address

4231 Postal CT Ste 201
Pasadena, MD 21122-4474

Phone

(443) 548-3733

Fax

(410) 360-1675

NPI assigned

Nov 2, 2022

Organization subpart

Yes

Parent organization

EVOLVE LIFE CENTERS IOP, LLCAs reported in NPPES

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

Authorized official

Name

Jessie Costley

Title

Administrator

Phone

(443) 548-3733

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Evolve Life Centers Iop LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pasadena, MD
  • NPI 1568123966

  O20220913000039

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Evolve Life Centers Iop LLC3 organizations share this tax ID, including this one

Part of

Evolve Life Centers Iop LLC

Other organizations with this tax ID 2

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

• Evolve Life Centers Iop LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pasadena, MD
  • NPI 1568123966
  NPD tax ID
• Evolve Life Centers Iop LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Pasadena, MD
  • NPI 1851838643
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Evolve Life Centers Iop LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Pasadena, MD
  • NPI 1851838643
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rachel Markus, LCSW-C

  • Clinical Social Worker
  • Hampstead, MD
  • NPI 1538554449
  NPD (past)

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1124735717",
    "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",
            "fax_number": "410-360-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4231 POSTAL CT STE 201",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211224474",
            "telephone_number": "443-548-3733",
            "fax_number": "410-360-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE LIFE CENTERS IOP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVOLVE LIFE CENTERS IOP, LLC",
        "enumeration_date": "2022-11-02",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "COSTLEY",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "443-548-3733"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200319801",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Senyo Essuah-Mensah, PHARM.D
• Ramiz Estafanos
• Tetyana Evans, PMHNP
• Evolve Health Partners
• Evolve Health Partners
• Evolve Life Centers Iop LLC
• Evolve Life Centers Iop LLC
• Evolve Life Centers LLC
• Evolve Residential, LLC
• Evolve Residential, LLC

• Substance Use Disorder Rehabilitation Clinic/Center in Pasadena, MD
• Providers in Pasadena, MD by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.