Chrysallis, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

HFD03-0229 Issued in DC

Legal business name

CHRYSALLIS, INC.

Practice address

3765 1St St SE
Washington, DC 20032-2313

Phone

(202) 561-4393

Fax

(301) 853-6756

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Ilene T. Wilson, RN BSN

Title

President & Ceo

Phone

(301) 853-6754

Specialties & licenses 1

Addresses

Other identifiers 4

Tax ID family

Chrysallis Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Chrysallis, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Hyattsville, MD
  • NPI 1306095617
  NPD tax ID

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221004800000",
    "number": "1548382401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6495 NEW HAMPSHIRE AVE",
            "address_2": "SUITE 303",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207833245",
            "telephone_number": "301-853-6754",
            "fax_number": "301-853-6756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3765 1ST ST SE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200322313",
            "telephone_number": "202-561-4393",
            "fax_number": "301-853-6756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRYSALLIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ILENE",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "301-853-6754",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN BSN"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "DC",
            "license": "HFD03-0229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026785400",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026786200",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025901600",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026784600",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Susanne Christov-Bakargiev, MSPT
• Chronicles Healthcare Services LLC
• Elise Vania Chrystelle Mbango Koum
• Daniel Alexander Chu, MD
• Elsa Chu
• Eugenia Gina Chu, MD
• Everett T Chu, M.D.

• Intellectual Disabilities Intermediate Care Facility in Washington, DC
• Providers in Washington, DC by specialty
• Intellectual Disabilities Intermediate Care Facility in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; 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.