Provider Demographics
NPI:1932494366
Name:PALS A CHRYSALIS HEALTH COMPANY
Entity Type:Organization
Organization Name:PALS A CHRYSALIS HEALTH COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BRACONE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:614-397-9585
Mailing Address - Street 1:222 W JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2731
Mailing Address - Country:US
Mailing Address - Phone:614-532-6420
Mailing Address - Fax:
Practice Address - Street 1:222 W JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2731
Practice Address - Country:US
Practice Address - Phone:614-532-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services