Provider Demographics
NPI:1457673931
Name:RAINBOW OF SUNSHINE II
Entity Type:Organization
Organization Name:RAINBOW OF SUNSHINE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-527-3083
Mailing Address - Street 1:307 CEDARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-2254
Mailing Address - Country:US
Mailing Address - Phone:910-527-3083
Mailing Address - Fax:910-868-3788
Practice Address - Street 1:307 CEDARWOOD ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2254
Practice Address - Country:US
Practice Address - Phone:910-527-3083
Practice Address - Fax:910-868-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805621Medicaid