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General NPI Number Information
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NPI Number | 1730556861
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Entity Type | Organization
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Legal Business Name | THE KALEIDOSCOPE CENTER LLC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 107 CHURCH ST
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City | MONTROSE
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State | PA
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Zip | 18801-1363
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Country | US
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Telephone | 570-904-4767
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Fax |
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Provider Business Mailing Address
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Address Line | 997 MAPLE GROVE RD
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City | MOSCOW
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State | PA
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Zip | 18444-6860
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Country | US
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Telephone | 570-955-9861
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MRS. KRISTINE ANN FELL
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Credential | OTR/L
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Telephone | 570-955-9861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | TCO150810JD4303
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License Number State | PA
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