1548494966 NPI number — RAINBOW 66 STOREHOUSE INC.

Table of content: (NPI 1548494966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548494966 NPI number — RAINBOW 66 STOREHOUSE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAINBOW 66 STOREHOUSE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548494966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 ATKINSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAURINBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28352-3715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-276-0766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 RIGSBEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-686-0165
Provider Business Practice Location Address Fax Number:
919-686-0167
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KIMMIE
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
910-276-0766

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , with the licence number:  MHL-032-053 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3418378 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com