Provider Demographics
NPI:1104176361
Name:RAINBOW ADULT CHILD FAMILY SERVICES
Entity type:Organization
Organization Name:RAINBOW ADULT CHILD FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTELL
Authorized Official - Middle Name:LANIECE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-706-7855
Mailing Address - Street 1:5016 BLUE ROSE ST.
Mailing Address - Street 2:
Mailing Address - City:N. LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081
Mailing Address - Country:US
Mailing Address - Phone:702-666-1626
Mailing Address - Fax:
Practice Address - Street 1:5016 BLUE ROSE ST
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2676
Practice Address - Country:US
Practice Address - Phone:702-666-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMIO195305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization