CHRYSALIS (NPI# 1407077613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407077613 |
| Entity Type | Organization |
| Organization Name | CHRYSALIS |
| Practice Address |
12985 Northline Rd Ste 103 Southgate MI 48195-1194 |
| Practice Telephone | 7342824630 |
| Practice Fax Number | 7342824684 |
| Mailing Telephone | 7342824630 |
| Mailing Fax Number | 7342824684 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. MARIBETH ALICE KNISLEY (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7342824630 |
| Authorized Official Credential | MSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1134304926 | Chrysalis | Community Health Worker | 57 Trails End Rd, Eureka, MT 59917-9332 | 2007-12-31 |
| 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 |
12985 NORTHLINE RD STE 103 |
| City | SOUTHGATE |
| State | MI |
| Zip Code | 48195-1194 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780206656 | Destiny D Harris | Social Worker | 14799, Southgate, MI 48195 | 2020-05-13 |
| 1285102368 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 16256 Fort St, Southgate, MI 48195 | 2018-11-07 |
| 1003382979 | Saran Charisse Watts | Case Manager/Care Coordinator | 31101 Allen Rd, Building 5, Southgate, MI 48195 | 2018-10-18 |
| 1255824025 | Kiesta Janell Lindsey | Social Worker | 13101 Allen Rd Bldg 4-f, Southgate, MI 48195 | 2018-06-07 |
| 1417473224 | Suzette Michele Watson | Nurse Practitioner | 14319 Dix-toledo, Southgate, MI 48195 | 2017-08-15 |
| 1275069486 | Liza Du Plessis | Student in an Organized Health Care Education/Training Program | 13111 Allen Road, Southgate, MI 48195 | 2017-05-08 |
| 1497290456 | Beaumont Health | Clinic/Center | 15777 Northline, Southgate, MI 48195 | 2016-12-30 |
| 1184172876 | Felicia Wilson | Licensed Practical Nurse | 15771 Wildemere, Southgate, MI 48195 | 2016-09-12 |
| 1225487978 | Stacey Petrick-strickland | Technician, Other | 12189 Agnes, Southgate, MI 48195 | 2016-06-03 |
| 1205298486 | Ashley Francis | Hearing Instrument Specialist | 18800 Eureka Rd., Southgate, MICHIGAN 48195 | 2016-03-25 |
| Find all providers in zip 48195 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199507 | Laura Lisa Gonzalez | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 7134 Blankenship Cir, Davison, MI 48423-2317 | 2020-09-17 |
| 1558984377 | Angel Patient Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12601 E Outer Dr, Detroit, MI 48224-4204 | 2020-05-27 |
| 1659990208 | Lydias House | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11667 152nd Ave, West Olive, MI 49460-9232 | 2020-04-14 |
| 1124667118 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2678 S Waverly Hwy, Lansing, MI 48911-6303 | 2019-12-23 |
| 1215579537 | Eden Prairie Residential Care Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 302 Welch Blvd, Flint, MI 48503-1105 | 2019-10-09 |
| 1518428333 | Alternative Adult Residence LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 19163 Woodingham Dr, Detroit, MI 48221-1650 | 2019-03-26 |
| 1245701960 | Teresa Elaine Guzman | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 130 Marvin St, Battle Creek, MI 49017-8040 | 2018-12-06 |
| 1508334764 | Marquette Staffing Agency, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 592 Blemhuber Ave, Marquette, MI 49855-4818 | 2018-11-06 |
| 1912481235 | Adrienne Flowers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18403 Kentucky St, Detroit, MI 48221-2029 | 2018-09-21 |
| 1417431487 | Helping Hands Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5116 18th Rd, Escanaba, MI 49829-9525 | 2018-09-17 |
| Find all providers with the same taxonomy | ||||
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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.