Healthcare Provider Details

I. General information

NPI: 1982106324
Provider Name (Legal Business Name): CHRYSALIS CARE I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7245 HARDING CIR
BUENA PARK CA
90620-4102
US

IV. Provider business mailing address

2331 W LINCOLN AVE STE 100
ANAHEIM CA
92801-5103
US

V. Phone/Fax

Practice location:
  • Phone: 714-886-2243
  • Fax:
Mailing address:
  • Phone: 714-349-6082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK MESIAS
Title or Position: CEO
Credential:
Phone: 714-349-6082