| Rainbow Cafe Lgbtq Center | |
|
120 N Illinois Ave Carbondale IL 62901-1450 | |
| (618) 525-9922 | |
| Not Available |
| Full Name | Rainbow Cafe Lgbtq Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 120 N Illinois Ave, Carbondale, Illinois |
| Authorized Official Name and Position | Carrie Lynn Vine (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9152178288 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rainbow Cafe Lgbtq Center 118 N Illinois Ave Carbondale IL 62901-1450 Ph: (618) 525-9922 | Rainbow Cafe Lgbtq Center 120 N Illinois Ave Carbondale IL 62901-1450 Ph: (618) 525-9922 |
| NPI Number | 1457033763 |
|---|---|
| Provider Enumeration Date | 08/04/2023 |
| Last Update Date | 11/05/2024 |
| Certification Date | 11/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457033763 | NPI | - | NPPES |
| BHC-2427502 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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