Healthcare Provider Details

I. General information

NPI: 1689566838
Provider Name (Legal Business Name): PROJECT RAINBOW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 SCOTT AVE
MORGANTOWN WV
26508-8804
US

IV. Provider business mailing address

PO BOX 1414
MORGANTOWN WV
26507-1414
US

V. Phone/Fax

Practice location:
  • Phone: 304-415-9114
  • Fax:
Mailing address:
  • Phone: 304-415-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIN SHELTON
Title or Position: PROJECT COORDINATOR
Credential:
Phone: 304-415-9114