Provider Demographics
NPI:1043037286
Name:EVOLUTION HOMES FOR CHILDREN AND YOUTH LLC
Entity type:Organization
Organization Name:EVOLUTION HOMES FOR CHILDREN AND YOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEO
Authorized Official - Middle Name:DEMONT
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:832-918-6757
Mailing Address - Street 1:2916 MISTY ELM LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3857
Mailing Address - Country:US
Mailing Address - Phone:832-918-7567
Mailing Address - Fax:
Practice Address - Street 1:2916 MISTY ELM LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-3857
Practice Address - Country:US
Practice Address - Phone:832-918-7567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities