Provider Demographics
NPI:1992355911
Name:EVOLUTION SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:EVOLUTION SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-713-7869
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-0657
Mailing Address - Country:US
Mailing Address - Phone:831-713-7869
Mailing Address - Fax:831-426-6891
Practice Address - Street 1:9344 E ZAYANTE RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9017
Practice Address - Country:US
Practice Address - Phone:831-713-7869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health