| Evolved, Llc | |
|
4905 E 29th St Tucson AZ 85711-6445 | |
| (910) 212-2261 | |
| (520) 704-6072 |
| Full Name | Evolved, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4905 E 29th St, Tucson, Arizona |
| Authorized Official Name and Position | Dennis Todd Shepard (CFO) |
| Authorized Official Contact | 9102122261 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolved, Llc 4905 E 29th St Tucson AZ 85711-6445 Ph: (910) 212-2261 | Evolved, Llc 4905 E 29th St Tucson AZ 85711-6445 Ph: (910) 212-2261 |
| NPI Number | 1780920033 |
|---|---|
| Provider Enumeration Date | 12/13/2012 |
| Last Update Date | 12/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780920033 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH-4071 (Arizona) | Primary |
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