Provider Demographics
NPI:1427252790
Name:RAINBOW GARDENS ALF #3
Entity type:Organization
Organization Name:RAINBOW GARDENS ALF #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-525-5466
Mailing Address - Street 1:1401 N.E. 176 ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-525-5466
Mailing Address - Fax:305-825-2852
Practice Address - Street 1:1401 N.E. 176 ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:305-525-5466
Practice Address - Fax:305-825-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10183310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility