Chrysalis

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

CHRYSALIS

Practice address

12985 Northline Rd Ste 103
Southgate, MI 48195-1194

Phone

(734) 282-4630

Fax

(734) 282-4684

NPI assigned

May 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Maribeth Alice Knisley, MSW

Title

Executive Director

Phone

(734) 282-4630

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407077613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12985 NORTHLINE RD STE 103",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951194",
            "telephone_number": "734-282-4630",
            "fax_number": "734-282-4684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12985 NORTHLINE RD STE 103",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951194",
            "telephone_number": "734-282-4630",
            "fax_number": "734-282-4684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRYSALIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KNISLEY",
        "authorized_official_first_name": "MARIBETH",
        "authorized_official_middle_name": "ALICE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "734-282-4630",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Southgate, MI
• Providers in Southgate, MI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.