Provider Demographics
NPI:1346601838
Name:RAINBOW CENTER OF MICHIGAN
Entity Type:Organization
Organization Name:RAINBOW CENTER OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:313-989-3743
Mailing Address - Street 1:12501 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3243
Mailing Address - Country:US
Mailing Address - Phone:313-989-3743
Mailing Address - Fax:
Practice Address - Street 1:12501 HAMILTON AVE.
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203
Practice Address - Country:US
Practice Address - Phone:313-989-3743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703114372302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization