Provider Demographics
NPI:1215144233
Name:OVER THE RAINBOW ADULT DAYCARE
Entity type:Organization
Organization Name:OVER THE RAINBOW ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-372-9599
Mailing Address - Street 1:2305 ELM RD. EXT.
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9217
Mailing Address - Country:US
Mailing Address - Phone:330-372-9599
Mailing Address - Fax:330-372-9579
Practice Address - Street 1:2305 ELM RD. EXT.
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9217
Practice Address - Country:US
Practice Address - Phone:330-372-9599
Practice Address - Fax:330-372-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2571AFH311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2043041Medicaid