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
State | License ID | Taxonomies |
---|---|---|
NJ | 2000361 | 343900000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) |