Provider Demographics
NPI:1457948648
Name:RAINBOW OF RESILIENCE LLC
Entity Type:Organization
Organization Name:RAINBOW OF RESILIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S,LICDC
Authorized Official - Phone:614-584-0765
Mailing Address - Street 1:3850 E LIVINGSTON AVE PO BOX 27183
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2006
Mailing Address - Country:US
Mailing Address - Phone:614-584-0765
Mailing Address - Fax:
Practice Address - Street 1:1247 ARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2006
Practice Address - Country:US
Practice Address - Phone:614-584-0765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260254Medicaid