Provider Demographics
NPI:1538953328
Name:EVIDENCE SUPPORT SERVICES
Entity type:Organization
Organization Name:EVIDENCE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:EBULOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-716-4638
Mailing Address - Street 1:2410 SUSAN HODGES PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8945
Mailing Address - Country:US
Mailing Address - Phone:240-716-4638
Mailing Address - Fax:
Practice Address - Street 1:2402 LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8983
Practice Address - Country:US
Practice Address - Phone:240-716-4638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health