Organization
CHRYSALLIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ILENE TONDELAYO WILSON RN BSN (PRESIDENT/ CEO)
(301) 853-6754
Entity
Organization
Contact information
Practice address
6495 NEW HAMPSHIRE AVE, SUITE 303, HYATTSVILLE, MD 20783-3245
(301) 853-6754
(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
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039289400
—
DC
Enumeration date
09/10/2008
Last updated
09/10/2008
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