1780425645 NPI number — EVOLVED INCORPORATED

Table of content: (NPI 1780425645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780425645 NPI number — EVOLVED INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVOLVED INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780425645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W 2ND ST UNIT 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89503-5696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-870-9654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W 2ND ST UNIT 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89503-5696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-870-9654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HICKOK
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
775-870-9654

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083080626 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com