Healthcare Provider Details

I. General information

NPI: 1134443229
Provider Name (Legal Business Name): KALEIDOSCOPE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12940 S. WESTERN STE 300
BLUE ISLAND IL
60406-1454
US

IV. Provider business mailing address

1340 S. DAMEN AVENUE MEZZANINE
CHICAGO IL
60608-1190
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-7200
  • Fax:
Mailing address:
  • Phone: 773-278-7200
  • Fax: 773-278-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number011126-13
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number011126-13
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS FINNEGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-278-7200