Healthcare Provider Details

I. General information

NPI: 1508237421
Provider Name (Legal Business Name): ENVISION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4267 CHAMBLEE TUCKER RD
DORAVILLE GA
30340-4501
US

IV. Provider business mailing address

4267 CHAMBLEE TUCKER RD
DORAVILLE GA
30340-4501
US

V. Phone/Fax

Practice location:
  • Phone: 678-670-6578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. GREELENSKY CHARLES
Title or Position: OWNER
Credential:
Phone: 678-670-6578