MEDICARE: RAINBOW HEALTH MINNESOTA

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1679027148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINBOW HEALTH MINNESOTA

Provider Business Mailing Address
First Line	:	2577 TERRITORIAL RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1500
Country	:	US
Telephone Number	:	612-341-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2577 TERRITORIAL RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114
Country	:	US
Telephone Number	:	612-341-2060
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRENDA SUSAN CLARK
Credential	:
Telephone Number	:	612-373-2407

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	05/03/2021

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Directions to “RAINBOW HEALTH MINNESOTA ” Practice Location

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