Provider Demographics
NPI:1801668801
Name:CHRYSALIS INC
Entity type:Organization
Organization Name:CHRYSALIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-707-2770
Mailing Address - Street 1:280 W PRAIRIE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9401
Mailing Address - Country:US
Mailing Address - Phone:208-770-2770
Mailing Address - Fax:208-770-2771
Practice Address - Street 1:280 W PRAIRIE AVE STE 3
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9401
Practice Address - Country:US
Practice Address - Phone:208-770-2770
Practice Address - Fax:208-770-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities