Provider Demographics
NPI:1568954105
Name:ENVISION UNLIMITED
Entity Type:Organization
Organization Name:ENVISION UNLIMITED
Other - Org Name:ENVISION WELLNESS PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE MANAGEMEN
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-506-3014
Mailing Address - Street 1:4411 N RAVENSWOOD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5802
Mailing Address - Country:US
Mailing Address - Phone:773-506-4313
Mailing Address - Fax:773-769-1476
Practice Address - Street 1:4411 N RAVENSWOOD AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:773-506-4313
Practice Address - Fax:773-769-1476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVISION UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-30
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
IL18004261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL18004Medicaid