Healthcare Provider Details

I. General information

NPI: 1568954105
Provider Name (Legal Business Name): ENVISION UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 N RAVENSWOOD AVE FL 1
CHICAGO IL
60640-5802
US

IV. Provider business mailing address

4411 N RAVENSWOOD AVE FL 1
CHICAGO IL
60640-5802
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-4313
  • Fax: 773-769-1476
Mailing address:
  • Phone: 773-506-4313
  • Fax: 773-769-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number18004
License Number StateIL

VIII. Authorized Official

Name: NATALIE A BLIDER
Title or Position: DIRECTOR OF REVENUE CYCLE MANAGEMEN
Credential:
Phone: 773-506-3014