Provider Demographics
NPI:1457333494
Name:RAINBOW OF NEW JERSEY, INC.
Entity Type:Organization
Organization Name:RAINBOW OF NEW JERSEY, INC.
Other - Org Name:RAINBOW CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-451-5000
Mailing Address - Street 1:849 BIG OAK RD
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4054
Mailing Address - Country:US
Mailing Address - Phone:856-451-5000
Mailing Address - Fax:856-455-7371
Practice Address - Street 1:849 BIG OAK RD
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-4054
Practice Address - Country:US
Practice Address - Phone:856-451-5000
Practice Address - Fax:856-455-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061704314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4498305Medicaid
NJ315014OtherBLUE CROSS
NJ315014AMedicare ID - Type Unspecified