Healthcare Provider Details

I. General information

NPI: 1841837713
Provider Name (Legal Business Name): RAINBOW OF LIFE BEHAVIORAL HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 10TH AVE N
LAKE WORTH BEACH FL
33461-3345
US

IV. Provider business mailing address

2115 10TH AVE N
LAKE WORTH BEACH FL
33461-3345
US

V. Phone/Fax

Practice location:
  • Phone: 561-506-3665
  • Fax: 561-444-2458
Mailing address:
  • Phone: 561-506-3665
  • Fax: 561-444-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LISSETTE COLLAZO
Title or Position: OWNER
Credential: LCSW
Phone: 561-667-2705