Provider Demographics
NPI:1578708483
Name:RAINBOW PEDIATRIC HOME HEALTH PLLC
Entity Type:Organization
Organization Name:RAINBOW PEDIATRIC HOME HEALTH PLLC
Other - Org Name:RAINBOW PEDIATRIC HOME HEALTH PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-362-4622
Mailing Address - Street 1:4211 GARDENDALE
Mailing Address - Street 2:SUITE A201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-362-4622
Mailing Address - Fax:210-615-7848
Practice Address - Street 1:4211 GARDENDALE
Practice Address - Street 2:SUITE A201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-362-4622
Practice Address - Fax:210-615-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28115649A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health