Provider Demographics
NPI:1720305931
Name:KALEIDOSCOPE KIDS CENTER LLC
Entity Type:Organization
Organization Name:KALEIDOSCOPE KIDS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:LETICIA
Authorized Official - Last Name:VILLAREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-412-6060
Mailing Address - Street 1:2701 MORGAN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1824
Mailing Address - Country:US
Mailing Address - Phone:956-454-5111
Mailing Address - Fax:
Practice Address - Street 1:7106 CHESTNUT OAK LN
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3063
Practice Address - Country:US
Practice Address - Phone:956-454-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109156225XP0200X
TX103783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty