Provider Demographics
NPI:1730863846
Name:EVO SOLUTIONS SERVICES LLC
Entity type:Organization
Organization Name:EVO SOLUTIONS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENEAPHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-706-3020
Mailing Address - Street 1:2153 E KESLER LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1486
Mailing Address - Country:US
Mailing Address - Phone:602-706-3020
Mailing Address - Fax:
Practice Address - Street 1:2153 E KESLER LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1486
Practice Address - Country:US
Practice Address - Phone:602-706-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child