Healthcare Provider Details

I. General information

NPI: 1174818223
Provider Name (Legal Business Name): RAINBOW CHILD AND FAMILY SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 W RUSSELL RD APT 2051
LAS VEGAS NV
89113-0771
US

IV. Provider business mailing address

7340 W RUSSELL RD APT 2051
LAS VEGAS NV
89113-0771
US

V. Phone/Fax

Practice location:
  • Phone: 215-498-3045
  • Fax:
Mailing address:
  • Phone: 215-498-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: INCORP SERVICES
Title or Position: MANAGEMENT
Credential:
Phone: 215-498-3045