Evolve Recovery Center at Millbury LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

EVOLVE RECOVERY CENTER AT MILLBURY LLC

Practice address

29 Main St Ste 300
Millbury, MA 01527-2005

Phone

(508) 876-3223

Fax

(508) 876-3224

NPI assigned

Aug 29, 2021

Last updated

Oct 11, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph Chelales

Title

VP of Compliance

Phone

(646) 285-4035

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susana Lugo, M.D.

  • Psychiatry Physician
  • Nashua, NH
  • NPI 1609946763

  MA

  Medicare reassignment NPD
• Jisselle Assad, APRN, FNP, PMHNP

  • Nurse Practitioner
  • Springfield, MA
  • NPI 1679145452
  Medicare reassignment
• Ann Nyambura Kamanga, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Worcester, MA
  • NPI 1659134369
  Medicare reassignment

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

{
    "created_epoch": "1630195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1407523244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27035",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071016735",
            "telephone_number": "508-876-3223",
            "fax_number": "508-876-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 MAIN ST STE 300",
            "city": "MILLBURY",
            "state": "MA",
            "postal_code": "015272005",
            "telephone_number": "508-876-3223",
            "fax_number": "508-876-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE RECOVERY CENTER AT MILLBURY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-29",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "CHELALES",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VP OF COMPLIANCE",
        "authorized_official_telephone_number": "646-285-4035"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marquis Earl
• Emmaus Counseling Services LLC
• Empire Vision Center, Inc. (Visionworks)
• Empowered Health Care Services (Empowered Health Care Services, LLC)
• Meryl Estabrook
• Evolve Recovery Center at Millbury Ma, LLC
• Kristen Nancy Feifert Clark, MSN CNM
• Robert K Ferguson, M.D.
• Daniel J Finn, RPH
• Lauren Fournier, M.A. BCBA

• Mental Illness Community Based Residential Treatment Facility in Millbury, MA
• Providers in Millbury, MA by specialty
• Mental Illness Community Based Residential Treatment Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.