Provider Demographics
NPI:1427623396
Name:EVOLVE GROWTH INITIATIVES LLC
Entity type:Organization
Organization Name:EVOLVE GROWTH INITIATIVES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-290-3354
Mailing Address - Street 1:300 N PACIFIC COAST HWY STE 2060
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4479
Mailing Address - Country:US
Mailing Address - Phone:424-290-3348
Mailing Address - Fax:
Practice Address - Street 1:710 COLE RANCH RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6611
Practice Address - Country:US
Practice Address - Phone:424-290-3348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOLVE GROWTH INITIATIVES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-24
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness