{"npi":"1851838643","type":"NPI-2","status":"active","name":{"display":"Evolve Life Centers Iop LLC","other":[],"organization_name":"EVOLVE LIFE CENTERS IOP LLC","authorised_official":"Jessie Costley"},"specialty":{"primary_taxonomy":"261QR0405X","primary_taxonomy_description":"Substance Use Disorder Rehabilitation Clinic/Center","slug":"substance-use-disorder-rehabilitation-clinic-center","schema_org_specialty":null,"all":[{"code":"324500000X","description":"Substance Abuse Rehabilitation Facility","primary":false,"state":null,"license":null},{"code":"261QR0405X","description":"Substance Use Disorder Rehabilitation Clinic/Center","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2528 MOUNTAIN RD","city":"PASADENA","state":"MD","postal_code":"211227203","country_code":"US","street_2":"SUITE 102-103 AND 201-204","phone":"4435483733","fax":"4103601675"},{"purpose":"MAILING","street_1":"2528 MOUNTAIN RD","city":"PASADENA","state":"MD","postal_code":"211227203","country_code":"US","phone":"4104567404","fax":"4103601675"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"200319800","state":"MD","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2017-01-31","last_updated":"2024-06-14","_meta":{"source":"NPPES","snapshot_date":"2024-06-14","doc_url":"https://findmynpi.com/api"}}