Provider Demographics
NPI:1356535413
Name:RAINBOW HOME HEALTH CARE AGENCY,INC.
Entity type:Organization
Organization Name:RAINBOW HOME HEALTH CARE AGENCY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DUNGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-515-5599
Mailing Address - Street 1:19401 S. VERMONT AVENUE
Mailing Address - Street 2:SUITE E 101
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1029
Mailing Address - Country:US
Mailing Address - Phone:310-515-5599
Mailing Address - Fax:310-515-5514
Practice Address - Street 1:19401 S. VERMONT AVENUE
Practice Address - Street 2:SUITE E 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1029
Practice Address - Country:US
Practice Address - Phone:310-515-5599
Practice Address - Fax:310-515-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000318251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
059008Medicare UPIN