Provider Demographics
NPI:1104431147
Name:EVOLVE HOME HEALTH
Entity type:Organization
Organization Name:EVOLVE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOGOL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-230-4215
Mailing Address - Street 1:22048 SHERMAN WAY STE 313
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3014
Mailing Address - Country:US
Mailing Address - Phone:747-230-4215
Mailing Address - Fax:
Practice Address - Street 1:22048 SHERMAN WAY STE 313
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3014
Practice Address - Country:US
Practice Address - Phone:747-230-4215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOLVE INVESTMENT GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health