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General NPI Number Information
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NPI Number | 1912327537
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Entity Type | Organization
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Legal Business Name | CHRYSALIS TO WINGS
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 30021 TOMAS SUITE 300
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2128
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Country | US
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Telephone | 949-916-6851
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Fax |
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Provider Business Mailing Address
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Address Line | 30021 TOMAS SUITE 300
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2128
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FRANCINE CARRIER-ZOREHKEY
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Credential | PH.D.
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Telephone | 949-916-6851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 73287
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License Number State | CA
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