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General NPI Number Information
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NPI Number | 1740819085
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Entity Type | Organization
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Legal Business Name | KALEIDOSCOPE LLC
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 41288 N CAMBRIA DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-3173
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Country | US
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Telephone | 480-504-3329
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Fax |
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Provider Business Mailing Address
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Address Line | 4051 E GAIL CT
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City | GILBERT
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State | AZ
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Zip | 85296-9646
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Country | US
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Telephone | 480-862-4855
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RABIYA TROTTER
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Credential |
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Telephone | 480-504-3329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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