Provider Demographics
NPI:1558364133
Name:RAINBOW HOSPICE AND PALLIATIVE CARE
Entity Type:Organization
Organization Name:RAINBOW HOSPICE AND PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:MCHALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-653-3210
Mailing Address - Street 1:1550 BISHOP CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-685-9900
Mailing Address - Fax:847-294-9613
Practice Address - Street 1:1550 BISHOP CT
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6039
Practice Address - Country:US
Practice Address - Phone:847-685-9900
Practice Address - Fax:847-294-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2000784251G00000X
IL251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632182OtherBLUECROSSBLUESHIELD PARTB
IL9523OtherBLUECROSS BLUESHIELD
IL203589Medicare ID - Type UnspecifiedMEDICARE PART B GROUP #
IL01632182OtherBLUECROSSBLUESHIELD PARTB
IL01632182OtherBLUECROSSBLUESHIELD PARTB