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General NPI Number Information
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NPI Number | 1932473758
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Entity Type | Organization
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Legal Business Name | RAINBOW BOARD & CARE
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 13557 3RD ST.
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City | YUCAIPA
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State | CA
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Zip | 92399-5345
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Country | US
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Telephone | 909-795-8144
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Fax | 909-795-5880
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Provider Business Mailing Address
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Address Line | 13557 3RD ST
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City | YUCAIPA
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State | CA
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Zip | 92399-5345
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Country | US
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Telephone | 909-795-8144
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Fax | 909-795-5880
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Authorized Official
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Title or Position | LICENSEE/ADMINISTRATOR
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Name | MARINO MANJARREZ
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Credential |
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Telephone | 909-795-8144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 366401737
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License Number State | CA
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