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General NPI Number Information
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NPI Number | 1134581093
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Entity Type | Organization
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Legal Business Name | CHRYSALIS NEVADA INC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 3460 W CHEYENNE AVE SUITE 100
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-8241
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Country | US
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Telephone | 702-227-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1443 W 800 N SUITE 103
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City | OREM
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State | UT
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Zip | 84057-2875
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Country | US
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Telephone | 801-655-4950
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARC ROBERT CHRISTENSEN
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Credential |
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Telephone | 801-655-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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