Provider Demographics
NPI:1407101595
Name:RAINBOW PARK ADULT DAY CARE CENTER, LLC
Entity Type:Organization
Organization Name:RAINBOW PARK ADULT DAY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-847-0004
Mailing Address - Street 1:1498 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11403 CRONHILL DR
Practice Address - Street 2:SUITES D-G
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6217
Practice Address - Country:US
Practice Address - Phone:410-363-7275
Practice Address - Fax:410-363-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care