Provider Demographics
NPI:1376863233
Name:ENVISION HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:ENVISION HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:HASTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-236-7424
Mailing Address - Street 1:PO BOX 7632
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28241-7632
Mailing Address - Country:US
Mailing Address - Phone:803-236-7424
Mailing Address - Fax:
Practice Address - Street 1:13507 FESTIVA CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4827
Practice Address - Country:US
Practice Address - Phone:803-236-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health