14D2207915 CLIA NUMBER - ENVISION UNLIMITED

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Laboratory Demographics

CLIA Number: 14D2207915

Facility Name: ENVISION UNLIMITED

Facility Address:
4436 W DIVERSY AVE
CHICAGO, IL
ZIP 60639
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Facility Phone Number: 773 766-9982

Facility Type: Other - SOCIAL SERVICE PROVIDER

Certificate Type: Waiver

NPI Number: 1033601687

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2207915
LAB Type	Other - SOCIAL SERVICE PROVIDER
Facility Name	ENVISION UNLIMITED
Street	4436 W DIVERSY AVE
City	CHICAGO
State	IL
ZIP	60639
Phone	773 766-9982
CertificateType	4
CertificateEffectiveDate	12/31/2022
CertificateExpirationDate	12/30/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024