Healthcare Provider Details

I. General information

NPI: 1164085890
Provider Name (Legal Business Name): ENVISION UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
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: 773-506-3014
  • Fax: 773-676-2137

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 MANAGEMEN
Credential:
Phone: 773-676-2137