Provider Demographics
NPI:1073705141
Name:THE RAINBOW CENTER FOR CHILDREN AND ADOLESCENTS
Entity Type:Organization
Organization Name:THE RAINBOW CENTER FOR CHILDREN AND ADOLESCENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:CGT-C
Authorized Official - Phone:901-755-1856
Mailing Address - Street 1:PO BOX 752552
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38175-2552
Mailing Address - Country:US
Mailing Address - Phone:901-755-1856
Mailing Address - Fax:
Practice Address - Street 1:1325 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2013
Practice Address - Country:US
Practice Address - Phone:901-755-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health