Provider Demographics
NPI:1013548866
Name:ENVISION CREATIVE SUPPORT FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:ENVISION CREATIVE SUPPORT FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING TECH
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-313-2628
Mailing Address - Street 1:PO BOX 200069
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-0069
Mailing Address - Country:US
Mailing Address - Phone:970-339-5360
Mailing Address - Fax:970-330-2261
Practice Address - Street 1:1050 37TH STREET
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-0069
Practice Address - Country:US
Practice Address - Phone:970-339-5360
Practice Address - Fax:970-330-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care