Provider Demographics
NPI:1275384208
Name:ENVISION UNLIMITED
Entity Type:Organization
Organization Name:ENVISION UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MH RCM
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-506-3014
Mailing Address - Street 1:8 S MICHIGAN AVE STE 1700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1135 N 9TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2943
Practice Address - Country:US
Practice Address - Phone:773-769-2139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVISION UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18004Medicaid