Healthcare Provider Details

I. General information

NPI: 1881532406
Provider Name (Legal Business Name): RAINBOW ROOF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 FLECK ST
DAWSON IL
62520-3199
US

IV. Provider business mailing address

209 FLECK ST
DAWSON IL
62520-3199
US

V. Phone/Fax

Practice location:
  • Phone: 217-685-2332
  • Fax: 217-960-8081
Mailing address:
  • Phone: 217-685-2332
  • Fax: 217-960-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN MARIE WOLF
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 217-622-7300