Provider Demographics
NPI:1972827814
Name:SHINING RAINBOW TRANSPORTAION INC
Entity Type:Organization
Organization Name:SHINING RAINBOW TRANSPORTAION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-332-4321
Mailing Address - Street 1:130 W 228TH ST
Mailing Address - Street 2:APT # 6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6605
Mailing Address - Country:US
Mailing Address - Phone:347-332-4321
Mailing Address - Fax:
Practice Address - Street 1:130 W 228TH ST
Practice Address - Street 2:APT # 6A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6605
Practice Address - Country:US
Practice Address - Phone:347-332-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646371720343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)