Provider Demographics
NPI:1750645834
Name:KHALEIDOSCOPE HEALTH CARE INC
Entity Type:Organization
Organization Name:KHALEIDOSCOPE HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M ALI
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:201-451-5425
Mailing Address - Street 1:127 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-3615
Mailing Address - Country:US
Mailing Address - Phone:201-451-5425
Mailing Address - Fax:201-451-7499
Practice Address - Street 1:127 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3615
Practice Address - Country:US
Practice Address - Phone:201-451-5425
Practice Address - Fax:201-451-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000361343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)