Provider Demographics
NPI:1598084550
Name:RAINBOW CENTER OF MICHIGAN
Entity Type:Organization
Organization Name:RAINBOW CENTER OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HARRIET
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-283-7378
Mailing Address - Street 1:PO BOX 725098
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-5098
Mailing Address - Country:US
Mailing Address - Phone:313-587-3092
Mailing Address - Fax:313-469-8530
Practice Address - Street 1:14733 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9545
Practice Address - Country:US
Practice Address - Phone:734-243-8707
Practice Address - Fax:734-243-8710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAINBOW CENTER OF MICHIGAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI580077261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2604097Medicaid