Provider Demographics
NPI:1912369786
Name:CHRYSALIS NEVADA INC
Entity Type:Organization
Organization Name:CHRYSALIS NEVADA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-655-4950
Mailing Address - Street 1:1443 W 800 N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2875
Mailing Address - Country:US
Mailing Address - Phone:801-655-4950
Mailing Address - Fax:801-655-4954
Practice Address - Street 1:3032 SILVER SAGE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-6167
Practice Address - Country:US
Practice Address - Phone:775-883-6060
Practice Address - Fax:775-883-6061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRYSALIS NEVADA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care