Provider Demographics
NPI:1821192097
Name:RAINBOW REHAB LLC
Entity Type:Organization
Organization Name:RAINBOW REHAB LLC
Other - Org Name:RAINBOW REHAB LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERSOLE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:678-432-4755
Mailing Address - Street 1:261 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4243
Mailing Address - Country:US
Mailing Address - Phone:678-432-4755
Mailing Address - Fax:678-432-4753
Practice Address - Street 1:300 EAGLES POINTE PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6384
Practice Address - Country:US
Practice Address - Phone:678-432-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy