1174957138 NPI number — RAINBOW COMMUNITY SUPPORT SERVICES

Table of content: (NPI 1174957138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174957138 NPI number — RAINBOW COMMUNITY SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAINBOW COMMUNITY SUPPORT SERVICES
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:
LOVING HANDS ADULT DAY CARE
Provider Other Organization Name Type Code:
3
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:
1174957138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48237-4738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-728-6437
Provider Business Mailing Address Fax Number:
313-334-4961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26847 GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48240-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-728-6437
Provider Business Practice Location Address Fax Number:
313-334-4961
Provider Enumeration Date:
08/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BRADLEY
Authorized Official First Name:
JOE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-728-6437

Provider Taxonomy Codes

  • Taxonomy code: 310500000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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