Provider Demographics
NPI:1841837713
Name:RAINBOW OF LIFE BEHAVIORAL HEALTH CENTER, LLC
Entity type:Organization
Organization Name:RAINBOW OF LIFE BEHAVIORAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-667-2705
Mailing Address - Street 1:2115 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3345
Mailing Address - Country:US
Mailing Address - Phone:561-506-3665
Mailing Address - Fax:561-444-2458
Practice Address - Street 1:2115 10TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-3345
Practice Address - Country:US
Practice Address - Phone:561-506-3665
Practice Address - Fax:561-444-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty