Provider Demographics
NPI:1215408240
Name:CHRYSALIS HEALTH OF TEXAS, PA
Entity Type:Organization
Organization Name:CHRYSALIS HEALTH OF TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-809-6796
Mailing Address - Street 1:386 PARK AVE S FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8804
Mailing Address - Country:US
Mailing Address - Phone:847-809-6796
Mailing Address - Fax:
Practice Address - Street 1:945 MCKINNEY ST # 14629
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-6308
Practice Address - Country:US
Practice Address - Phone:424-334-9213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104823954Medicaid