Provider Demographics
NPI:1720683105
Name:RAINBOW PLACE INC
Entity Type:Organization
Organization Name:RAINBOW PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:MANTHIA
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-482-3360
Mailing Address - Street 1:522 S RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7514
Mailing Address - Country:US
Mailing Address - Phone:954-482-3360
Mailing Address - Fax:954-894-1188
Practice Address - Street 1:522 S RAINBOW DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7514
Practice Address - Country:US
Practice Address - Phone:954-482-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care