Provider Demographics
NPI:1124278502
Name:EVOLUTION HEALTHCARE SERVICES INC.
Entity type:Organization
Organization Name:EVOLUTION HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:B
Authorized Official - Last Name:EDET
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-233-5525
Mailing Address - Street 1:148 HAVENRIDGE
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6269
Mailing Address - Country:US
Mailing Address - Phone:469-233-5525
Mailing Address - Fax:972-635-5296
Practice Address - Street 1:148 HAVENRIDGE
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6269
Practice Address - Country:US
Practice Address - Phone:469-233-5525
Practice Address - Fax:972-635-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING251G00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based