Healthcare Provider Details

I. General information

NPI: 1386774164
Provider Name (Legal Business Name): ENVISION UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SOUTH MICHIGAN AVENUE SUITE 1700
CHICAGO IL
60603-3353
US

IV. Provider business mailing address

8 SOUTH MICHIGAN AVENUE SUITE 1700
CHICAGO IL
60603-3353
US

V. Phone/Fax

Practice location:
  • Phone: 312-346-6230
  • Fax: 312-346-2218
Mailing address:
  • Phone: 312-346-6230
  • Fax: 312-346-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTIN V MACRAE
Title or Position: PRESIDENT CHIEF EXECUTIVE OFFICER
Credential:
Phone: 312-346-6230