Provider Demographics
NPI:1518536986
Name:THE CHRYSALIS CENTER, INC
Entity Type:Organization
Organization Name:THE CHRYSALIS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CONTRACTS AND PAYOR RELATIONS
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:772-214-1010
Mailing Address - Street 1:3800 W BROWARD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1018
Mailing Address - Country:US
Mailing Address - Phone:772-214-1010
Mailing Address - Fax:
Practice Address - Street 1:825 NW 23RD AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3574
Practice Address - Country:US
Practice Address - Phone:954-587-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105777800Medicaid