MEDICARE: RAINBOW'S LLC

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	343900000X	Non-emergency Medical Transport (VAN)	L10657	MI

General Provider Information

NPI Number	:	1396197695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINBOW'S LLC

Provider Business Mailing Address
First Line	:	15045 MANNING ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1969
Country	:	US
Telephone Number	:	248-508-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	15045 MANNING ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1969
Country	:	US
Telephone Number	:	248-508-9112
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/ OWNER
Name	:	AFIAVI DADO
Credential	:
Telephone Number	:	248-508-9112

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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Directions to “RAINBOW'S LLC ” Practice Location

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