NPIMap

Organization Active NPI

Kaleidoscope Eating Disorders and Diet Recovery Center

  • Health Service Clinic/Center
  • Portland, ME
National Provider Identifier
1356960728
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
KALEIDOSCOPE EATING DISORDERS AND DIET RECOVERY CENTER
Practice address
75 Market St Ste 304
Portland, ME 04101-5040
Phone
(207) 205-5505
NPI assigned
Apr 15, 2020
Last updated
Apr 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy Grimm, RDNNPI 1013032507
Title
Co-Owner
Phone
(207) 205-5505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

75 Market St Ste 304
Portland, ME 04101-5040

Mailing address

75 Market St Ste 304
Portland, ME 04101-5040
Phone (207) 205-5505

National Provider Directory

National Provider Directory

Locations

75 Market St
Ste 304
Portland, ME 04101
Phone (207) 205-5505

253 Main St
Frnt
Yarmouth, ME 04096

253 Main St
Ste 4
Yarmouth, ME 04096
Phone (207) 370-8270

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586908800000",
    "number": "1356960728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 MARKET ST STE 304",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041015040",
            "telephone_number": "207-205-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 MARKET ST STE 304",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041015040",
            "telephone_number": "207-205-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALEIDOSCOPE EATING DISORDERS AND DIET RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "207-205-5505",
        "authorized_official_credential": "RDN"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.