MEDICARE: RAINBOW TREE, INC.

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	:	1558509836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINBOW TREE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 336
Second Line	:
City	:	PINEVILLE
State	:	NC
Zip	:	28134-0336
Country	:	US
Telephone Number	:	704-281-4516
Fax Number	:	704-759-3712

Provider Business Practice Location Address
First Line	:	10405 CAMELBACK CIRCLE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4518
Country	:	US
Telephone Number	:	704-281-4516
Fax Number	:	704-759-3712

Authorized Official
Title or Position	:	PRESIDENT/EXECUTIVE DIRECTOR
Name	:	MS. DONETTA BUTLER
Credential	:	MS
Telephone Number	:	704-281-4516

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	01/26/2009

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