Provider Demographics
NPI:1184596058
Name:KALEIDOSCOPE RECOVERY & PEER CENTER, LLC
Entity type:Organization
Organization Name:KALEIDOSCOPE RECOVERY & PEER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CEO FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE ANTONIA
Authorized Official - Middle Name:ANTONIA
Authorized Official - Last Name:PERLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-483-5646
Mailing Address - Street 1:4485 WADSWORTH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3309
Mailing Address - Country:US
Mailing Address - Phone:303-483-5646
Mailing Address - Fax:303-800-9789
Practice Address - Street 1:4485 WADSWORTH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3309
Practice Address - Country:US
Practice Address - Phone:303-483-5646
Practice Address - Fax:303-800-9789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KALEIDOSCOPE RECOVERY & PEER CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-20
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000246585Medicaid