Provider Demographics
NPI:1013440304
Name:CHRYSALIS SPECTRUM LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:CHRYSALIS SPECTRUM LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:RASCHAL
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DBA
Authorized Official - Phone:281-918-9852
Mailing Address - Street 1:6819 PRAIRIE DUNES DR.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-1785
Mailing Address - Country:US
Mailing Address - Phone:281-918-9852
Mailing Address - Fax:
Practice Address - Street 1:118 VINTAGE PARK BLVD W449
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-407-1662
Practice Address - Fax:832-218-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services