Provider Demographics
NPI:1699074138
Name:THE CHRYSALIS CENTER
Entity type:Organization
Organization Name:THE CHRYSALIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANUAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:EQS
Authorized Official - Phone:954-587-1008
Mailing Address - Street 1:3521 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1048
Mailing Address - Country:US
Mailing Address - Phone:954-587-1008
Mailing Address - Fax:954-587-0080
Practice Address - Street 1:7156 COLONY CLUB DR APT 207
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7832
Practice Address - Country:US
Practice Address - Phone:561-536-6135
Practice Address - Fax:954-587-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness