Chrysalis
LBN: Tubman
Chrysalis is an health care organization with primary practice located at 4432 Chicago Ave S , Minneapolis MN 55407-3519. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder. Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) is the primary health care specialty.
Tubman can be contacted via phone (612) 870-2444, or through Dusso, Beverly via phone (612) 767-6690.
Contact Information
Primary practice address
4432 Chicago Ave S
Minneapolis MN 55407-3519
Phone: (612) 870-2444
Fax: (612) 870-2428
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) | 261QM0801X | 800487-2-MCH | Minnesota |
| Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder | 261QR0405X | 800488-3-CDT | Minnesota |
Profile Details
| NPI number | 1295866911 |
|---|---|
| LBN Legal business name | Tubman |
| DBA Doing business as | Chrysalis |
| Authorized official | Dusso, Beverly |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 7th, 2007 |
| Last updated | Nov 12th, 2008 - about 16 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1295866911 | NPPES |
| Minnesota | MEDICAID | 575255800 | |
| Minnesota | MEDICAID | 257080700 | |
| Minnesota | Other | 9026CH |
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