Provider Demographics
NPI:1386444560
Name:EVOLUTIONS DETOX
Entity type:Organization
Organization Name:EVOLUTIONS DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-220-0234
Mailing Address - Street 1:8418 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4433
Mailing Address - Country:US
Mailing Address - Phone:818-220-0234
Mailing Address - Fax:818-279-2869
Practice Address - Street 1:8418 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4433
Practice Address - Country:US
Practice Address - Phone:747-202-0028
Practice Address - Fax:818-279-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility