Healthcare Provider Details

I. General information

NPI: 1992302178
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

9020 S STONY ISLAND AVE
CHICAGO IL
60617-3508
US

IV. Provider business mailing address

5080 N ELSTON AVE
CHICAGO IL
60630-2459
US

V. Phone/Fax

Practice location:
  • Phone: 312-346-6230
  • Fax:
Mailing address:
  • Phone: 773-506-3014
  • 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: DIR. OF RCM
Credential:
Phone: 773-769-4313