Organization
CHRYSALIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIBETH ALICE KNISLEY MSW (EXECUTIVE DIRECTOR)
(734) 282-4630
Entity
Organization
Contact information
Practice address
12985 NORTHLINE RD STE 103, SOUTHGATE, MI 48195-1194
(734) 282-4630
(734) 282-4684
Mailing address
12985 NORTHLINE RD STE 103, SOUTHGATE, MI 48195-1194
(734) 282-4630
(734) 282-4684
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/02/2007
Last updated
08/22/2020
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