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General NPI Number Information
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NPI Number | 1881532406
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Entity Type | Organization
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Legal Business Name | RAINBOW ROOF LLC
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 209 FLECK ST
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City | DAWSON
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State | IL
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Zip | 62520-3199
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Country | US
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Telephone | 217-685-2332
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Fax | 217-960-8081
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Provider Business Mailing Address
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Address Line | 209 FLECK ST
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City | DAWSON
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State | IL
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Zip | 62520-3199
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Country | US
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Telephone | 217-685-2332
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Fax | 217-960-8081
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | KRISTIN MARIE WOLF
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Credential | RN
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Telephone | 217-622-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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