Provider Demographics
NPI:1902200116
Name:KALEIDOSCOPE INTERVENTIONS
Entity Type:Organization
Organization Name:KALEIDOSCOPE INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-372-6813
Mailing Address - Street 1:125 E NASA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1900
Mailing Address - Country:US
Mailing Address - Phone:321-265-4429
Mailing Address - Fax:321-765-6434
Practice Address - Street 1:5830 US HIGHWAY 1 STE 104
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5704
Practice Address - Country:US
Practice Address - Phone:321-609-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP2008OtherUNITED HEALTHCARE
FL014022600Medicaid
0089AOtherBLUE CROSS BLUE SHEILD
4642140OtherCIGNA
4953527OtherAETNA
5670969OtherCIGNA
5670970OtherCIGNA
GF43SOtherFLORIDA BLUE
FL017449700Medicaid