Provider Demographics
NPI:1487199196
Name:RAINBOW VALLEY GROUP HOME, INC.
Entity Type:Organization
Organization Name:RAINBOW VALLEY GROUP HOME, INC.
Other - Org Name:RAINBOW VALLEY MERCED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:209-722-0202
Mailing Address - Street 1:2841 G ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2133
Mailing Address - Country:US
Mailing Address - Phone:209-722-0202
Mailing Address - Fax:209-385-9921
Practice Address - Street 1:1227 CAVALAIRE CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9542
Practice Address - Country:US
Practice Address - Phone:209-385-9917
Practice Address - Fax:209-385-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247203971322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children