NPIMap

Organization Active NPI

Evolve Residential, LLC

  • Substance Abuse Rehabilitation Facility
  • Pasadena, MD
National Provider Identifier
1154964880
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
8003A Leeland Dr
Pasadena, MD 21122-2495
Phone
(410) 456-7404
NPI assigned
Oct 25, 2019
Organization subpart
No

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 Specialist
Phone
(443) 548-3733

Specialties & licenses 1

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

Addresses

Primary practice location

8003A Leeland Dr
Pasadena, MD 21122-2495

Mailing address

8003A Leeland Dr
Pasadena, MD 21122-2495

Other identifiers 1

IdentifierTypeStateIssuer
907752901MedicaidMD

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": "1571961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752364800000",
    "number": "1154964880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003A LEELAND DR",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211222495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8003A LEELAND DR",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211222495",
            "telephone_number": "410-456-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE RESIDENTIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-25",
        "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 SPECIALIST",
        "authorized_official_telephone_number": "443-548-3733"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "907752901",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, 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.