Provider Demographics
NPI:1386255321
Name:EVOLVE AND HEAL WELLNESS CENTER
Entity type:Organization
Organization Name:EVOLVE AND HEAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-680-9899
Mailing Address - Street 1:1024 W OWENS AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2520
Mailing Address - Country:US
Mailing Address - Phone:702-680-9899
Mailing Address - Fax:
Practice Address - Street 1:1024 W OWENS AVE STE 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2520
Practice Address - Country:US
Practice Address - Phone:702-680-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty