Provider Demographics
NPI:1720831365
Name:BLUE RAINBOW OF AUTISM LLC
Entity Type:Organization
Organization Name:BLUE RAINBOW OF AUTISM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:YASMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-355-4371
Mailing Address - Street 1:8552 CLARIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2849
Mailing Address - Country:US
Mailing Address - Phone:786-443-1082
Mailing Address - Fax:
Practice Address - Street 1:3600 SOUTH STATE ROAD 7 STE 7
Practice Address - Street 2:SUITE 229
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023
Practice Address - Country:US
Practice Address - Phone:786-443-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health