=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063956654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAINBOW HOMES NON-PROFIT HOUSING CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2016
-----------------------------------------------------
Last Update Date | 04/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2111 ADELPHA AVE
-----------------------------------------------------
City | HOLT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48842-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-699-8454
-----------------------------------------------------
Fax | 517-906-6120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2111 ADELPHA AVE
-----------------------------------------------------
City | HOLT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48842-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-699-8454
-----------------------------------------------------
Fax | 517-906-6120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. DANIELLE MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-699-8454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------