Provider Demographics
NPI:1316773609
Name:EVOLVE YOUTH SERVICES LLC
Entity type:Organization
Organization Name:EVOLVE YOUTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESHAWNDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-888-0292
Mailing Address - Street 1:2032 RUSTIC RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3233
Mailing Address - Country:US
Mailing Address - Phone:518-888-0292
Mailing Address - Fax:
Practice Address - Street 1:2032 RUSTIC RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3233
Practice Address - Country:US
Practice Address - Phone:518-888-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOLVE YOUTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle