Healthcare Provider Details

I. General information

NPI: 1114636743
Provider Name (Legal Business Name): THE CHRYSALIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S. MAIN ST.
LOS ANGELES CA
90013
US

IV. Provider business mailing address

522 S. MAIN ST.
LOS ANGELES CA
90013
US

V. Phone/Fax

Practice location:
  • Phone: 213-806-6340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK LORANGER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 213-806-6342