Provider Demographics
NPI:1386774164
Name:ENVISION UNLIMITED
Entity type:Organization
Organization Name:ENVISION UNLIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIEF EXECUTIVE OFFICER
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 1:8 SOUTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3353
Mailing Address - Country:US
Mailing Address - Phone:312-346-6230
Mailing Address - Fax:312-346-2218
Practice Address - Street 1:8 SOUTH MICHIGAN AVENUE
Practice Address - Street 2:SUITE 1700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3353
Practice Address - Country:US
Practice Address - Phone:312-346-6230
Practice Address - Fax:312-346-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630144OtherBLUE CROSS BLUE SHIELD