Provider Demographics
NPI:1679398184
Name:RAINBOW MIRACLES LLC
Entity type:Organization
Organization Name:RAINBOW MIRACLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCH BERRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-237-7769
Mailing Address - Street 1:9429 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5440
Mailing Address - Country:US
Mailing Address - Phone:786-237-7769
Mailing Address - Fax:
Practice Address - Street 1:9429 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5440
Practice Address - Country:US
Practice Address - Phone:786-237-7769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty