# CHRYSALIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407077613
- **Authorized official:** MRS. MARIBETH ALICE KNISLEY MSW (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (734) 282-4630

## Contact information

- **Practice address:** 12985 NORTHLINE RD STE 103, SOUTHGATE, MI 48195-1194
- **Practice address phone:** (734) 282-4630
- **Practice address fax:** (734) 282-4684
- **Mailing address:** 12985 NORTHLINE RD STE 103, SOUTHGATE, MI 48195-1194
- **Mailing address phone:** (734) 282-4630
- **Mailing address fax:** (734) 282-4684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/02/2007
- **Last updated:** 08/22/2020