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NPI Code Detail

MEDICARE: CHRYSALIS SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE INC

MEDICARE: CHRYSALIS SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1305S00000XPoint of ServiceBH4093AZ

General Provider Information

NPI Number : 1033263694
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRYSALIS SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE INC
Provider Business Mailing Address
First Line : 2055 WEST NORTHERN AVENUE
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5157
Country : US
Telephone Number : 602-955-9059
Fax Number : 602-955-0165
Provider Business Practice Location Address
First Line : 2055 WEST NORTHERN AVENUE
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5157
Country : US
Telephone Number : 602-955-9059
Fax Number : 602-955-0165
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. PATRICIA KLAHR
Credential : BSW
Telephone Number : 602-955-9059
Provider Enumeration Date : 01/22/2007
Last Update Date : 11/21/2012

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Directions to “CHRYSALIS SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE INC ” Practice Location

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