Provider Demographics
NPI:1518467190
Name:RAINBOW RESIDENTIALS
Entity Type:Organization
Organization Name:RAINBOW RESIDENTIALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARNELL-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-819-3130
Mailing Address - Street 1:193 EAST AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2341
Mailing Address - Country:US
Mailing Address - Phone:330-819-4202
Mailing Address - Fax:330-961-9909
Practice Address - Street 1:193 EAST AVE STE 103
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2341
Practice Address - Country:US
Practice Address - Phone:330-819-4202
Practice Address - Fax:330-961-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2812406Medicaid