Healthcare Provider Details

I. General information

NPI: 1356835805
Provider Name (Legal Business Name): ENVISION UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 N NASHVILLE AVE
CHICAGO IL
60634-1429
US

IV. Provider business mailing address

5080 N ELSTON AVE
CHICAGO IL
60630-2459
US

V. Phone/Fax

Practice location:
  • Phone: 773-283-5613
  • Fax:
Mailing address:
  • Phone: 773-506-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDA A BRUGGEMANN
Title or Position: BILLING COORDINATOR
Credential: LPC
Phone: 773-506-3201