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Organization
CHRYSALLIS, INC.
Active
Organization
CHRYSALLIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ILENE T. WILSON RN BSN (PRESIDENT & CEO)
(301) 853-6754
Entity
Organization
Contact information
Practice address
3765 1ST ST SE, WASHINGTON, DC 20032-2313
(202) 561-4393
(301) 853-6756
Mailing address
6495 NEW HAMPSHIRE AVE, SUITE 303, HYATTSVILLE, MD 20783-3245
(301) 853-6754
(301) 853-6756
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
HFD03-0229
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025901600
—
DC
05
—
026784600
—
DC
05
—
026785400
—
DC
05
—
026786200
—
DC
Enumeration date
04/04/2007
Last updated
09/10/2008
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