Healthcare Provider Details

I. General information

NPI: 1205749066
Provider Name (Legal Business Name): ENVISION QUALITY SUPPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6364 S HIGHLAND DR STE 201
MURRAY UT
84121-2117
US

IV. Provider business mailing address

6364 S HIGHLAND DR STE 201
MURRAY UT
84121-2117
US

V. Phone/Fax

Practice location:
  • Phone: 801-209-1357
  • Fax:
Mailing address:
  • Phone: 801-209-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: KRISSIE FULLMER
Title or Position: EXECUTIVE DIRECTOR
Credential: SSW
Phone: 801-209-1357