Healthcare Provider Details

I. General information

NPI: 1215634969
Provider Name (Legal Business Name): RAINBOW TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 WOODSTREAM BLVD
STAFFORD VA
22556-4632
US

IV. Provider business mailing address

299 WOODSTREAM BLVD
STAFFORD VA
22556-4632
US

V. Phone/Fax

Practice location:
  • Phone: 703-598-8620
  • Fax:
Mailing address:
  • Phone: 703-589-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CARLOTA HALL DE WILKS
Title or Position: CEO
Credential:
Phone: 703-598-8620