CHRYSALIS (NPI# 1134304926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134304926 |
| Entity Type | Organization |
| Organization Name | CHRYSALIS |
| Practice Address |
57 Trails End Rd Eureka MT 59917-9332 |
| Practice Telephone | 4068895577 |
| Practice Fax Number | 4068895576 |
| Mailing Telephone | 4068895577 |
| Mailing Fax Number | 4068895576 |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2007-12-31 |
| Authorized Official Name | MR. KENNY PANNELL (VICE PRESIDENT) |
| Authorized Official Telephone | 4068895577 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 172V00000X | Community Health Worker | IL | Other Service Providers | |
| Y | 174400000X | Specialist | IL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | BLUE CROSS BLUESHIELD | 75473 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407077613 | Chrysalis | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12985 Northline Rd Ste 103, Southgate, MI 48195-1194 | 2007-05-02 |
| 1770921868 | Chrysalis | Psychiatric Residential Treatment Facility | 77 Trails End Rd, Eureka, MT 59917-9332 | 2013-06-11 |
| 1346573417 | Chrysalis | Counselor | 1312 Hamilton Pl, Suite 105, High Point, NC 27265 | 2009-09-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Chrysalis | 2020 E. Bijoiu, Number 3, Colorado Springs, CO 80909 |
| New York State Corporations | CHRYSALIS ACUPUNCTURE, PLLC | 928 Broadway, Ste 801, New York, Ny 10010 |
| Oregon Corporations, Companies and Business Names | CHRYSALIS ADVENTURES, LLC | 3250 Ne Mlk Jr Blvd #111, Portland, OR 97212 |
| Oregon Corporations, Companies and Business Names | CHRYSALIS ADVISORY GROUP | 480 Ne Bellevue Dr, Suite 114, Bend, OR 97701 |
| Oregon Corporations, Companies and Business Names | CHRYSALIS AERIAL ACADEMY | 345 Ne 8th St, Gresham, OR 97030 |
| Colorado Business Entities | Chrysalis Alchemy, llc | 18323 E Union Dr, Aurora, CO 80015 |
| Colorado Business Entities | Chrysalis Angel Fund LLC | 1900 Wazee Street, Suite 300, Denver, CO 80202 |
| Colorado Business Entities | Chrysalis Archaeological & Environmental Consulting, LLC | 1002 Montrose Ave, Colorado Springs, CO 80905 |
| System for Award Management (SAM) Entities | CHRYSALIS ARCHAEOLOGY | 4110 Quentin Rd, Brooklyn, NY 11234-4322 |
| System for Award Management (SAM) Entities | CHRYSALIS ART CONSERVATION, INC. | 799 Main St. Ste L, Half Moon Bay, CA 94019-1946 |
| Street Address |
57 TRAILS END RD |
| City | EUREKA |
| State | MT |
| Zip Code | 59917-9332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821142217 | Kenny Zack Pannell | Counselor | 57 Trails End Rd, Eureka, MT 59917-9332 | 2007-01-22 |
| 1811176092 | Chrysalis School | Residential Treatment Facility, Emotionally Disturbed Children | 57 Trails End Rd, Eureka, MT 59917-9332 | 2007-10-24 |
| 1518089754 | Jane E Fineberg | Social Worker | 57 Trails End Rd, Chrysalis School, Eureka, MT 59917-9332 | 2007-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154892370 | Danielle Bartley | Counselor | 235 7th Street East, Eureka, MT 59917 | 2018-12-16 |
| 1619462801 | Carl William Florey | Massage Therapist | 626 Sherman Creek Road, Eureka, MT 59917 | 2018-06-29 |
| 1609367143 | Chelsea Mae Torres | Massage Therapist | 1711 Hwy 37, Eureka, MT 59917 | 2018-05-21 |
| 1265921639 | Glacier Clinic LLC | Counselor | 99 Mills Spring Rd Ste 1, Eureka, MT 59917 | 2018-05-01 |
| 1568759249 | Lincoln County Community Health Center | Clinic/Center | 100 Dewey Ave, Eureka, MT 59917 | 2011-07-01 |
| 1346534393 | Jacob Sparks | Marriage & Family Therapist | 77 Trails End Rd, Eureka, MT 59917 | 2011-06-07 |
| 1588953632 | Grizzly Eye Center, PC | Optometrist | 317 Dewey Avenue, Eureka, MT 59917 | 2011-03-29 |
| 1881996981 | Home Sweet Home | Assisted Living Facility | 144 Tobacco Valley View Drive, Eureka, MT 59917 | 2010-11-22 |
| 1679889240 | Larry J Lawler | Counselor | 403 1st. Ave. East, Eureka, MT 59917 | 2010-08-20 |
| 1689859654 | Karen Joann Lee | Dental Hygienist | 1210 Highway 93 N, Eureka, MT 59917 | 2008-01-08 |
| Find all providers in zip 59917 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962866608 | Pampered Hands and Feet | Specialist | 2245 Stanford Dr, Eureka, CA 95503-7053 | 2016-04-08 |
| 1134469513 | Marilyn Bell Brende | Specialist | 1427 T St, Eureka, CA 95501-2577 | 2013-02-22 |
| 1295037703 | Dee Anne Wettstein | Specialist | 709 S Hilldale Ave, Eureka, IL 61530-1528 | 2010-12-03 |
| 1730324468 | Robert E. Soper, M.d. | Specialist | 517 3rd St Ste 5, Eureka, CA 95501-0460 | 2008-12-09 |
| 1558540765 | Amy Kempton | Specialist | 1984 1/2 Simmons Rd, Eureka, CA 95503-6563 | 2007-10-24 |
| 1326127432 | Robert Patrick Sylvester | Specialist | 1670 Myrtle Ave, Eureka, CA 95501-1403 | 2006-11-02 |
| 1669559308 | Wayne E Roslosnik | Specialist | 2462 Russ St, Eureka, CA 95501-4754 | 2006-11-01 |
| 1134159197 | Steven James Wilson | Specialist | 2306 Dean St, Eureka, CA 95501-3209 | 2006-07-04 |
| 1508892738 | Michael David Fratkin | Specialist | 2440 23rd St Ste B, Eureka, CA 95501-3203 | 2006-06-22 |
| 1316984842 | Leo Roy Leer | Specialist | 2675 Harris St, Eureka, CA 95503-4806 | 2006-06-01 |
| Find all providers in EUREKA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.