Provider Demographics
NPI:1609368778
Name:ENVISION UNLIMITED
Entity Type:Organization
Organization Name:ENVISION UNLIMITED
Other - Org Name:LELAND
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUGGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:773-506-3201
Mailing Address - Street 1:5080 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2459
Mailing Address - Country:US
Mailing Address - Phone:773-506-3201
Mailing Address - Fax:
Practice Address - Street 1:2728 W LELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-676-2145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVISION UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-04
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
IL18004261QM0801X
IL320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness