Active NPI
Chrysalis Foundation for Mental Health, Inc
- Community/Behavioral Health Agency
- Roxboro, NC
National Provider Identifier
1487796116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- MHL-073-031
- Legal business name
- CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC
- Practice address
- 211 Webb St
Roxboro, NC 27573-5338 - Phone
- (336) 599-6030
- NPI assigned
- Feb 12, 2007
- Last updated
- Jul 17, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jefferson Douglas Parker
- Title
- Acting Executive Director
- Phone
- (919) 933-0828
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | MHL-073-031 | NC | Primary |
Addresses
Primary practice location
211 Webb St
Roxboro, NC 27573-5338
Mailing address
101 E Weaver St
Suite G-7
Carrboro, NC 27510-2370
Phone (919) 933-0770
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8301148S | Medicaid | NC | |
| 8301148 | Medicaid | NC |
National Provider Directory
National Provider Directory- Tax ID family
- The Chrysalis Foundation for Mental Health Inc-Hope Meadow Program
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Pittsboro, NC
- NPI 1821130642
-
- Substance Abuse Rehabilitation Facility
- Pittsboro, NC
- NPI 1093828881
Locations
211 Webb St
Roxboro, NC 27573
Phone (336) 599-6030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1184630400000",
"number": "1487796116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E WEAVER ST",
"address_2": "SUITE G-7",
"city": "CARRBORO",
"state": "NC",
"postal_code": "275102370",
"telephone_number": "919-933-0770",
"fax_number": "919-933-0767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 WEBB ST",
"city": "ROXBORO",
"state": "NC",
"postal_code": "275735338",
"telephone_number": "336-599-6030"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-17",
"status": "A",
"authorized_official_last_name": "PARKER",
"authorized_official_first_name": "JEFFERSON",
"authorized_official_middle_name": "DOUGLAS",
"authorized_official_title_or_position": "ACTING EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "919-933-0828",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NC",
"license": "MHL-073-031",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301148S",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301148",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roxboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.