Provider Demographics
NPI:1235230111
Name:CENTRAL CITY AIDS NETWORK, INC.
Entity Type:Organization
Organization Name:CENTRAL CITY AIDS NETWORK, INC.
Other - Org Name:THE RAINBOW CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:T
Authorized Official - Last Name:FAMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:NON PROFIT AIDS SERV
Authorized Official - Phone:478-750-8080
Mailing Address - Street 1:2020 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2028
Mailing Address - Country:US
Mailing Address - Phone:478-750-8080
Mailing Address - Fax:478-750-1032
Practice Address - Street 1:2020 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2028
Practice Address - Country:US
Practice Address - Phone:478-750-8080
Practice Address - Fax:478-750-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANONE NEEDED251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable