Provider Demographics
NPI:1003302886
Name:CHRYSALIS HEALTH OHIO, LLC
Entity Type:Organization
Organization Name:CHRYSALIS HEALTH OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:JO-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-216-3031
Mailing Address - Street 1:1524 SUNSET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1380
Mailing Address - Country:US
Mailing Address - Phone:800-691-6113
Mailing Address - Fax:
Practice Address - Street 1:1524 SUNSET BLVD STE A
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1380
Practice Address - Country:US
Practice Address - Phone:800-691-6113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0351215Medicaid