Rainbow Cafe Lgbtq Center

LBN: Rainbow Cafe Lgbtq Center
Rainbow Cafe Lgbtq Center is an health care organization with primary practice located at 120 N Illinois Ave , Carbondale IL 62901-1450. The organization recently has 4 registered licenses in different health care specialties including Other Service Providers / Peer Specialist, Speech, Language and Hearing Service Providers / Speech-Language Pathologist, Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health. Ambulatory Health Care Facilities / Adolescent and Children Mental Health is the primary health care specialty. Rainbow Cafe Lgbtq Center can be contacted via phone (618) 525-9922, or through Socorro, Alexander R via phone (618) 525-9922.

Contact Information

Primary practice address
120 N Illinois Ave Carbondale IL 62901-1450
Phone: (618) 525-9922
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Socorro, Alexander R
Phone: (618) 525-9922

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X

Profile Details

NPI number 1457033763
LBN Legal business name Rainbow Cafe Lgbtq Center
DBA Doing business as
Authorized official Socorro, Alexander R
Entity Organization
Organization subpart 1 No
Enumeration date Aug 4th, 2023
Last updated Jul 16th, 2026 - about 3 months ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457033763 NPPES
Illinois MEDICAID BHC-2427502

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