NPIMap

Organization Active NPI

Evolve365 Therapy LLC

  • Community/Behavioral Health Agency
  • Racine, WI
National Provider Identifier
1609514694
Registry record updated May 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EVOLVE365 THERAPY LLC
Practice address
715 Kingston Ave
Racine, WI 53402-4046
Phone
(262) 989-3737
NPI assigned
May 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2022

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

Authorized official

Name
Molly GrosseNPI 1194156760
Title
Organizer
Phone
(262) 989-3737

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

715 Kingston Ave
Racine, WI 53402-4046

Mailing address

715 Kingston Ave
Racine, WI 53402-4046

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1609514694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 KINGSTON AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534024046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 KINGSTON AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534024046",
            "telephone_number": "262-989-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE365 THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "GROSSE",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "262-989-3737"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; 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.