Healthcare Provider Details

I. General information

NPI: 1598116576
Provider Name (Legal Business Name): ENVISION TOTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NE 2ND CT
BOCA RATON FL
33432-1805
US

IV. Provider business mailing address

1455 NE 2ND CT
BOCA RATON FL
33432-1805
US

V. Phone/Fax

Practice location:
  • Phone: 561-302-7778
  • Fax:
Mailing address:
  • Phone: 561-302-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: LESLIE ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 561-302-7778