NPIMap

Organization Active NPI

Evolve Life Centers Iop LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Pasadena, MD
National Provider Identifier
1851838643
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
EVOLVE LIFE CENTERS IOP LLC
Practice address
2528 Mountain Rd
Suite 102-103 and 201-204
Pasadena, MD 21122-7203
Phone
(443) 548-3733
Fax
(410) 360-1675
NPI assigned
Jan 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

2528 Mountain Rd
Suite 102-103 and 201-204
Pasadena, MD 21122-7203

Mailing address

2528 Mountain Rd
Pasadena, MD 21122-7203
Phone (410) 456-7404

Other identifiers 1

IdentifierTypeStateIssuer
200319800MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Evolve Life Centers Iop LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

2528 Mountain Rd
Pasadena, MD 21122
Phone (410) 841-9647

2528 Mountain Rd
Ste 102103
Pasadena, MD 21122
Phone (443) 548-3733

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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": "1485820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1851838643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 MOUNTAIN RD",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211227203",
            "telephone_number": "410-456-7404",
            "fax_number": "410-360-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 MOUNTAIN RD",
            "address_2": "SUITE 102-103 AND 201-204",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211227203",
            "telephone_number": "443-548-3733",
            "fax_number": "410-360-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE LIFE CENTERS IOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-31",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "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": "200319800",
            "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 Jun 14, 2024; 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.