Provider Demographics
NPI:1629792601
Name:RAINBOW ABA THERAPY LLC
Entity Type:Organization
Organization Name:RAINBOW ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-215-6495
Mailing Address - Street 1:20 TRUDY LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4676
Mailing Address - Country:US
Mailing Address - Phone:216-215-6495
Mailing Address - Fax:
Practice Address - Street 1:101 PARK AVENUE STE 1300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:216-215-6495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty