Provider Demographics
NPI:1588925267
Name:CHRYSALIS-NEVADA INC.
Entity type:Organization
Organization Name:CHRYSALIS-NEVADA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-812-2444
Mailing Address - Street 1:1443 W 800 N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2875
Mailing Address - Country:US
Mailing Address - Phone:855-219-7136
Mailing Address - Fax:
Practice Address - Street 1:5595 EQUITY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2589
Practice Address - Country:US
Practice Address - Phone:775-322-6061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health