Healthcare Provider Details

I. General information

NPI: 1841855319
Provider Name (Legal Business Name): RAINBOW ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 BELCASTRO ST
LAS VEGAS NV
89117-2103
US

IV. Provider business mailing address

1823 BELCASTRO ST
LAS VEGAS NV
89117-2103
US

V. Phone/Fax

Practice location:
  • Phone: 702-858-4559
  • Fax: 810-885-0572
Mailing address:
  • Phone: 702-858-4559
  • Fax: 810-885-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE CROCK
Title or Position: ADMINISTRATOR
Credential: RFA
Phone: 702-858-4559