Healthcare Provider Details

I. General information

NPI: 1174957138
Provider Name (Legal Business Name): RAINBOW COMMUNITY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26847 GRAND RIVER AVE
REDFORD MI
48240-1544
US

IV. Provider business mailing address

PO BOX 47038
OAK PARK MI
48237-4738
US

V. Phone/Fax

Practice location:
  • Phone: 313-728-6437
  • Fax: 313-334-4961
Mailing address:
  • Phone: 313-728-6437
  • Fax: 313-334-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMI

VIII. Authorized Official

Name: JOE S. BRADLEY
Title or Position: PRESIDENT
Credential:
Phone: 313-728-6437