Provider Demographics
NPI:1609303932
Name:RAINBOW HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:RAINBOW HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUVUATAW
Authorized Official - Middle Name:
Authorized Official - Last Name:LOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-778-0562
Mailing Address - Street 1:2035 COUNTY ROAD D E STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5301
Mailing Address - Country:US
Mailing Address - Phone:651-778-0562
Mailing Address - Fax:651-778-9967
Practice Address - Street 1:2035 COUNTY ROAD D E STE 200
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5301
Practice Address - Country:US
Practice Address - Phone:651-778-0562
Practice Address - Fax:651-778-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA455433300Medicaid
MNM328678000Medicaid
MN69239OtherHEALTH PARTNERS
MN170909OtherUCARE
MNA073455100Medicaid