Provider Demographics
NPI:1285738476
Name:CHRYSALIS NEVADA, INC.
Entity type:Organization
Organization Name:CHRYSALIS NEVADA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MMHC
Authorized Official - Phone:801-805-1640
Mailing Address - Street 1:223 W 520 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4696
Mailing Address - Country:US
Mailing Address - Phone:801-805-1640
Mailing Address - Fax:801-805-6733
Practice Address - Street 1:223 W 520 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4696
Practice Address - Country:US
Practice Address - Phone:801-805-1640
Practice Address - Fax:801-805-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities