Provider Demographics
NPI:1093522047
Name:CHRYSALIS HEALTH OHIO, LLC
Entity type:Organization
Organization Name:CHRYSALIS HEALTH OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:JO-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-216-3031
Mailing Address - Street 1:1524 SUNSET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1380
Mailing Address - Country:US
Mailing Address - Phone:800-691-6113
Mailing Address - Fax:740-264-2422
Practice Address - Street 1:1524 SUNSET BLVD STE A
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1380
Practice Address - Country:US
Practice Address - Phone:800-691-6113
Practice Address - Fax:740-264-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty