Provider Demographics
NPI:1336440619
Name:ENVISION UNLIMITED FOSTER CARE PROGRAM
Entity Type:Organization
Organization Name:ENVISION UNLIMITED FOSTER CARE PROGRAM
Other - Org Name:CARC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MACRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-346-6230
Mailing Address - Street 1:5333 S GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4303
Mailing Address - Country:US
Mailing Address - Phone:773-241-5700
Mailing Address - Fax:773-241-5702
Practice Address - Street 1:5333 S GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4303
Practice Address - Country:US
Practice Address - Phone:773-241-5700
Practice Address - Fax:773-241-5702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVISION UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL004181OtherDEPARTMENT OF CHILDREN AND FAMILY SERVICES