Provider Demographics
NPI:1922274638
Name:RAINBOW ENHANCED ACADEMIC DEVELOPERS INC
Entity Type:Organization
Organization Name:RAINBOW ENHANCED ACADEMIC DEVELOPERS INC
Other - Org Name:READ INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-694-2610
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-0124
Mailing Address - Country:US
Mailing Address - Phone:704-694-2610
Mailing Address - Fax:704-694-2616
Practice Address - Street 1:148 TRENCH ROAD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-8169
Practice Address - Country:US
Practice Address - Phone:704-694-6357
Practice Address - Fax:704-694-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL004008322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604143Medicaid