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General NPI Number Information
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NPI Number | 1245859701
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Entity Type | Organization
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Legal Business Name | ENVISION CREATIVE SUPPORT FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 1050 37TH ST
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City | EVANS
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State | CO
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Zip | 80620-2115
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Country | US
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Telephone | 970-313-2628
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 200069
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City | EVANS
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State | CO
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Zip | 80620-0069
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Country | US
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Telephone | 970-313-2628
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Fax |
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Authorized Official
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Title or Position | BILLING TECH
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Name | LORI JEAN FLEMING
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Credential |
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Telephone | 970-313-2628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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