NPIMap

Organization Active NPI

Chrysalis Utah, LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Orem, UT
National Provider Identifier
1891898045
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
CHRYSALIS UTAH, LLC
Practice address
1443 W 800 N
Suite 103
Orem, UT 84057-2875
Phone
(801) 655-4950
Fax
(801) 655-4954
NPI assigned
Sep 6, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Marc Robert Christensen, MMHC
Title
Chief Operations Officer
Phone
(801) 655-4950

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X UT Primary
Mental Health Counselor 101YM0800X
Behavior Analyst 103K00000X

Addresses

Primary practice location

1443 W 800 N
Suite 103
Orem, UT 84057-2875

Mailing address

1443 W 800 N
Suite 103
Orem, UT 84057-2875
Phone (801) 655-4950

Other identifiers 1

IdentifierTypeStateIssuer
788007788140MedicaidUT

Other names 1

  • Chrysalis Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070726000156 UT Part B Supplier - Clinic/Group Practice 4284735846 Receives reassigned benefits from 11 practitioners
Practice locations: Cedar City, UT; Provo, UT

National Provider Directory

National Provider Directory
Tax ID family
Chrysalis Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

401 N 2150 W
Cedar City, UT 84721
Phone (435) 586-4078

660 N Airport Rd
Cedar City, UT 84721
Phone (435) 477-2816

525 W 465 N
Ste 120
Providence, UT 84332
Phone (385) 297-1758

1501 S 40 E
Ste 390
Provo, UT 84606

4933 S 1500 W
Ste 210
Riverdale, UT 84405
Phone (801) 604-1455

230 N 1680 E
Ste Op
St George, UT 84790
Phone (801) 604-1455

Practitioners & affiliated clinicians

Practitioners 118

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 118

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1891898045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1443 W 800 N",
            "address_2": "SUITE 103",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572875",
            "telephone_number": "801-655-4950",
            "fax_number": "801-655-4954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1443 W 800 N",
            "address_2": "SUITE 103",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572875",
            "telephone_number": "801-655-4950",
            "fax_number": "801-655-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRYSALIS UTAH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-07-21",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "801-655-4950",
        "authorized_official_credential": "MMHC"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "UT",
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "788007788140",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chrysalis",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Chrysalis",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.