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General NPI Number Information
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NPI Number | 1083904320
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Entity Type | Organization
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Legal Business Name | RAINBOW ACRES
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 2120 W RESERVATION LOOP RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-8408
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Country | US
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Telephone | 928-567-5231
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Fax | 928-567-9059
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Provider Business Mailing Address
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Address Line | 2120 W RESERVATION LOOP RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-8408
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Country | US
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Telephone | 928-567-5231
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Fax | 928-567-9059
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Authorized Official
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Title or Position | VP FINANCE
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Name | PAUL HIGGINS
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Credential |
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Telephone | 928-554-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL1870C
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License Number State | AZ
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