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General NPI Number Information
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NPI Number | 1609599315
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Entity Type | Organization
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Legal Business Name | RAINBOW ABA LLC
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 100 N PATTERSON ST STE 117
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City | VALDOSTA
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State | GA
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Zip | 31601-5570
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Country | US
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Telephone | 404-590-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N PATTERSON ST STE 117
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City | VALDOSTA
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State | GA
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Zip | 31601-5570
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Country | US
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Telephone | 440-841-3857
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MOSHE JACOBOVITCH
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Credential |
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Telephone | 440-841-3857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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