Healthcare Provider Details

I. General information

NPI: 1093828881
Provider Name (Legal Business Name): THE CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC.-HOPE MEADOW PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 PENNY LN
PITTSBORO NC
27312-4918
US

IV. Provider business mailing address

101 E WEAVER ST STE. G-7
CARRBORO NC
27510-2370
US

V. Phone/Fax

Practice location:
  • Phone: 919-968-8680
  • Fax: 919-968-9970
Mailing address:
  • Phone: 919-933-0770
  • Fax: 919-933-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-019017
License Number StateNC

VIII. Authorized Official

Name: MS. JEAN THERESE SUTTER
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 919-933-0770