Provider Demographics
NPI:1255330262
Name:RAIN BEAR LTD
Entity Type:Organization
Organization Name:RAIN BEAR LTD
Other - Org Name:DELL'S BRA BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOBSER
Authorized Official - Suffix:
Authorized Official - Credentials:BOC CMF
Authorized Official - Phone:703-691-1668
Mailing Address - Street 1:9858A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3908
Mailing Address - Country:US
Mailing Address - Phone:703-691-1668
Mailing Address - Fax:703-691-0965
Practice Address - Street 1:9858A MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3908
Practice Address - Country:US
Practice Address - Phone:703-691-1668
Practice Address - Fax:703-691-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0588170001Medicare NSC