Provider Demographics
NPI:1558837682
Name:CHRYSALIS TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:CHRYSALIS TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-754-7970
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-0847
Mailing Address - Country:US
Mailing Address - Phone:307-754-7970
Mailing Address - Fax:307-333-0470
Practice Address - Street 1:137 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2409
Practice Address - Country:US
Practice Address - Phone:307-754-7970
Practice Address - Fax:307-333-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder