Provider Demographics
NPI:1043335615
Name:RAINBOW FAMILY SERVICES
Entity Type:Organization
Organization Name:RAINBOW FAMILY SERVICES
Other - Org Name:CATHOLIC COMMUNITY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-390-2600
Mailing Address - Street 1:PO BOX 20400
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97307-0400
Mailing Address - Country:US
Mailing Address - Phone:503-390-2600
Mailing Address - Fax:503-390-8629
Practice Address - Street 1:800 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4408
Practice Address - Country:US
Practice Address - Phone:503-472-2240
Practice Address - Fax:503-390-8629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLETTER OF APPROVAL320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR261545OtherPROVIDER NUMBER
OR230442OtherPROVIDER NUMBER