Provider Demographics
NPI:1851460992
Name:RAINBOW OMEGA, INC.
Entity Type:Organization
Organization Name:RAINBOW OMEGA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:STENTSON
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-831-0919
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:EASTABOGA
Mailing Address - State:AL
Mailing Address - Zip Code:36260-0740
Mailing Address - Country:US
Mailing Address - Phone:256-831-0919
Mailing Address - Fax:256-831-0942
Practice Address - Street 1:100 HOPE DR
Practice Address - Street 2:
Practice Address - City:EASTABOGA
Practice Address - State:AL
Practice Address - Zip Code:36260-7363
Practice Address - Country:US
Practice Address - Phone:256-831-0919
Practice Address - Fax:256-831-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4958170IMedicaid