MEDICARE: ENVISION UNLIMITED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1144827320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION UNLIMITED

Provider Business Mailing Address
First Line	:	5080 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2459
Country	:	US
Telephone Number	:	303-667-9772
Fax Number	:

Provider Business Practice Location Address
First Line	:	4919 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3514
Country	:	US
Telephone Number	:	773-769-2139
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE MGMT
Name	:	NATALIE BLIDER
Credential	:
Telephone Number	:	303-667-9772

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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