Organization
ENVISION-CREATIVE SUPPORT FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYLU WALTON (EXECUTIVE DIRECTOR)
(970) 339-5360
Entity
Organization
Contact information
Practice address
1050 37TH ST, EVANS, CO 80620-2115
(970) 339-5360
(970) 330-2261
Mailing address
PO BOX 200069, EVANS, CO 80620-0069
(970) 339-5360
(970) 330-2261
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50057367
—
CO
Enumeration date
03/21/2007
Last updated
10/11/2016
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