EVOLVE LIFE CENTERS IOP LLC NPI 1124735717

NPI Information

NPI: 1124735717
Provider Name: EVOLVE LIFE CENTERS IOP LLC
Classification: Clinic/Center - 261QR0405X
Specialization: Rehabilitation, Substance Use Disorder
Entity Type: Organization
Address: 4231 POSTAL CT STE 201
PASADENA, MD
ZIP 21122
Phone: (443) 548-3733

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NPI Details

EVOLVE LIFE CENTERS IOP LLC is a rehabilitation and substance use disorder clinic center in Pasadena, MD. EVOLVE LIFE CENTERS IOP LLC NPI is 1124735717. The provider is registered as an organization entity type.

The provider's business location address is:

4231 POSTAL CT STE 201
PASADENA, MD
ZIP 21122-474
Phone: (443) 548-3733
Fax: (410) 360-1675

The provider's authorized official is Jessie Costley .
The authorized official title is Administrator and has the following contact phone number (443) 548-3733.

The enumeration date for this NPI number is 11/2/2022 and was last updated on 6/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	324500000X	Substance Abuse Rehabilitation Facility				No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200319801	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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