Provider Demographics
NPI:1689326423
Name:RAINBOW GROUP HOME INC
Entity Type:Organization
Organization Name:RAINBOW GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-303-6126
Mailing Address - Street 1:PO BOX 160037
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0037
Mailing Address - Country:US
Mailing Address - Phone:321-303-6126
Mailing Address - Fax:
Practice Address - Street 1:1288 CARDINAL CT
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-1101
Practice Address - Country:US
Practice Address - Phone:321-303-6126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690663039Medicaid