Healthcare Provider Details

I. General information

NPI: 1326975392
Provider Name (Legal Business Name): CHRYSALIS SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 EPSILON DR
DERWOOD MD
20855-2511
US

IV. Provider business mailing address

7520 EPSILON DR
DERWOOD MD
20855-2511
US

V. Phone/Fax

Practice location:
  • Phone: 202-961-2660
  • Fax:
Mailing address:
  • Phone: 202-961-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JONNAE TINSON
Title or Position: CEO
Credential:
Phone: 202-961-2660