=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396197695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAINBOW'S LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2016
-----------------------------------------------------
Last Update Date | 07/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15045 MANNING ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48205-1969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-508-9112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15045 MANNING ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48205-1969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-508-9112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/ OWNER
-----------------------------------------------------
Name | AFIAVI DADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-508-9112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | L10657
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------