| Evolution Life Services Llc | |
|
420 W Broad St Richmond VA 23220-4221 | |
| (804) 681-2023 | |
| (804) 533-1498 |
| Full Name | Evolution Life Services Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 420 W Broad St, Richmond, Virginia |
| Authorized Official Name and Position | Keesha L Borden (CEO) |
| Authorized Official Contact | 8046812023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Life Services Llc 6903 Alder Grove Dr Henrico VA 23228-2663 Ph: (804) 681-5331 | Evolution Life Services Llc 420 W Broad St Richmond VA 23220-4221 Ph: (804) 681-2023 |
| NPI Number | 1144006107 |
|---|---|
| Provider Enumeration Date | 09/06/2023 |
| Last Update Date | 05/16/2024 |
| Certification Date | 05/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144006107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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