Provider Demographics
NPI:1609146109
Name:RAINBOW RIDGE#2&#3,INC.
Entity Type:Organization
Organization Name:RAINBOW RIDGE#2&#3,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:HOME PROVIDER
Authorized Official - Phone:478-289-9000
Mailing Address - Street 1:181 RAINBOW RDG
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-4413
Mailing Address - Country:US
Mailing Address - Phone:478-289-9000
Mailing Address - Fax:478-289-6945
Practice Address - Street 1:181 RAINBOW RDG
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-4413
Practice Address - Country:US
Practice Address - Phone:478-289-9000
Practice Address - Fax:478-289-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053010291315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA018090102AMedicaid