Organization
EVOLVE WELLNESS & IV HYDRATION CENTER LLC
Active
Parent organization
EVOLVE WELLNESS & IV HYDRATION CENTER LLC
Other names
Evolve Mental Health and Wellness
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVOLVE WELLNESS & IV HYDRATION CENTER LLC
Authorized official
TAMESHIA WIGGINS APRN (NP-C)
(419) 314-9535
Entity
Organization
Contact information
Practice address
5330 HEATHERDOWNS BLVD STE 207, TOLEDO, OH 43614-4644
(419) 314-9535
(419) 469-5495
Mailing address
5330 HEATHERDOWNS BLVD STE 207, TOLEDO, OH 43614-4644
(419) 314-9535
(419) 469-5495
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
11/28/2022
Last updated
11/19/2024
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