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General NPI Number Information
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NPI Number | 1659234714
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Entity Type | Organization
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Legal Business Name | CHRYSALIS INC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 280 W PRAIRIE AVE STE 3
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9401
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Country | US
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Telephone | 208-770-2770
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Fax | 208-770-2771
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Provider Business Mailing Address
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Address Line | 280 W PRAIRIE AVE STE 3
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9401
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Country | US
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Telephone | 208-770-2770
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Fax | 208-770-2771
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Authorized Official
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Title or Position | CEO
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Name | TERRI K JOHNSON
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Credential | BS
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Telephone | 208-770-2770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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