Provider Demographics
NPI:1417122193
Name:RAINBOW HOSPICE
Entity Type:Organization
Organization Name:RAINBOW HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-685-3300
Mailing Address - Street 1:444 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3263
Mailing Address - Country:US
Mailing Address - Phone:847-685-9900
Mailing Address - Fax:847-685-6390
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:SUITE 145
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-685-9900
Practice Address - Fax:847-685-6390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
203589Medicare PIN