MEDICARE: OVER THE RAINBOW ADULT DAYCARE

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	311ZA0620X	Adult Care Home Facility	2571AFH	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215144233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVER THE RAINBOW ADULT DAYCARE

Provider Business Mailing Address
First Line	:	2305 ELM RD. EXT.
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9217
Country	:	US
Telephone Number	:	330-372-9599
Fax Number	:	330-372-9579

Provider Business Practice Location Address
First Line	:	2305 ELM RD. EXT.
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9217
Country	:	US
Telephone Number	:	330-372-9599
Fax Number	:	330-372-9579

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. DAWNA FYE
Credential	:
Telephone Number	:	330-372-9599

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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