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General NPI Number Information
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NPI Number | 1962627273
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Entity Type | Organization
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Legal Business Name | CHRYSALIS HOUSE, INC.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1589 HILL RISE DRIVE
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City | LEXINGTON
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State | KY
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Zip | 40504
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Country | US
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Telephone | 859-977-2502
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Fax | 859-233-9231
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Provider Business Mailing Address
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Address Line | 1589 HILL RISE DRIVE
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City | LEXINGTON
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State | KY
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Zip | 40504
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Country | US
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Telephone | 859-977-2502
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Fax | 859-233-9231
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LISA MINTON
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Credential |
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Telephone | 859-977-2502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 810207
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License Number State | KY
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