Healthcare Provider Details

I. General information

NPI: 1689989337
Provider Name (Legal Business Name): OUR RAINBOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 NW 40TH CT
OPA LOCKA FL
33054-6262
US

IV. Provider business mailing address

16150 NW 40TH CT
OPA LOCKA FL
33054-6262
US

V. Phone/Fax

Practice location:
  • Phone: 305-628-5384
  • Fax:
Mailing address:
  • Phone: 305-628-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SYLVIA REYNOLDS ROLLE
Title or Position: OWNER
Credential:
Phone: 305-628-5384