Healthcare Provider Details

I. General information

NPI: 1144827320
Provider Name (Legal Business Name): ENVISION UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 N CLARK ST
CHICAGO IL
60640-3514
US

IV. Provider business mailing address

5080 N ELSTON AVE
CHICAGO IL
60630-2459
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-2139
  • Fax:
Mailing address:
  • Phone: 303-667-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NATALIE BLIDER
Title or Position: DIRECTOR OF REVENUE CYCLE MGMT
Credential:
Phone: 303-667-9772