Provider Demographics
NPI:1417560335
Name:CHRYSALIS HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:CHRYSALIS HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-200-0784
Mailing Address - Street 1:1 ANNETTE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3441
Mailing Address - Country:US
Mailing Address - Phone:847-402-0007
Mailing Address - Fax:
Practice Address - Street 1:1005 E STATE ST STE E
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2151
Practice Address - Country:US
Practice Address - Phone:740-200-0784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)