Organization
EVOLVE RESIDENTIAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE COSTLEY (LICENSING SPECIALIST)
(443) 548-3733
Entity
Organization
Contact information
Practice address
8003A LEELAND DR, PASADENA, MD 21122-2495
(410) 456-7404
Mailing address
8003A LEELAND DR, PASADENA, MD 21122-2495
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
907752901
—
MD
Enumeration date
10/25/2019
Last updated
07/13/2025
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