Provider Demographics
NPI:1710380175
Name:RAINE INDUSTRIES
Entity Type:Organization
Organization Name:RAINE INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCKESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-620-0330
Mailing Address - Street 1:5963 OLIVAS PARK DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7666
Mailing Address - Country:US
Mailing Address - Phone:805-620-0330
Mailing Address - Fax:
Practice Address - Street 1:5963 OLIVAS PARK DR
Practice Address - Street 2:SUITE F
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7666
Practice Address - Country:US
Practice Address - Phone:805-620-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18604332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies