Provider Demographics
NPI:1518347616
Name:CHRYSALIS HOUSE, INC.
Entity Type:Organization
Organization Name:CHRYSALIS HOUSE, INC.
Other - Org Name:CHRYSALIS HOUSE HEALTHY START
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-483-8870
Mailing Address - Street 1:4500 PARK HEIGHTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-483-8870
Mailing Address - Fax:410-483-8871
Practice Address - Street 1:4500 PARK HEIGHTS AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-483-8870
Practice Address - Fax:410-483-8871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRYSALIS HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility