MEDICARE: MS. LENEE NICOLE RAINEY MHPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1063629244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LENEE NICOLE RAINEY MHPP

Provider Business Mailing Address
First Line	:	9400 STAGECOACH RD
Second Line	:	1311
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-7059
Country	:	US
Telephone Number	:	501-993-4287
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 STAGECOACH RD
Second Line	:	1311
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-7059
Country	:	US
Telephone Number	:	501-993-4287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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