Basic Information
| Provider Information | |||||||||
| NPI: | 1134581093 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRYSALIS NEVADA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1443 W 800 N | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840572875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016554950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3460 W CHEYENNE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890328241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022277300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTENSEN | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8016554950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 385H00000X | Y | Respite Care Facility | Respite Care |
No ID Information.