Provider Demographics
NPI:1710403852
Name:THE CHRYSALIS CENTER, LLC
Entity Type:Organization
Organization Name:THE CHRYSALIS CENTER, LLC
Other - Org Name:CHRYSALIS YOUTH & FAMILY SOLUTIONS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-603-9810
Mailing Address - Street 1:10380 PERKINS ROAD
Mailing Address - Street 2:#84685
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-5397
Mailing Address - Country:US
Mailing Address - Phone:225-603-9810
Mailing Address - Fax:
Practice Address - Street 1:2900 WESTFORK DR STE 401
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827
Practice Address - Country:US
Practice Address - Phone:225-603-9810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health