Provider Demographics
NPI:1770755142
Name:RAINBOW ADULT FAMILY HOME, INC.
Entity type:Organization
Organization Name:RAINBOW ADULT FAMILY HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:DURANTE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING ASSISTANT
Authorized Official - Phone:360-896-9417
Mailing Address - Street 1:6001 NE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5114
Mailing Address - Country:US
Mailing Address - Phone:360-896-9417
Mailing Address - Fax:360-896-9417
Practice Address - Street 1:6001 NE 162ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5114
Practice Address - Country:US
Practice Address - Phone:360-896-9417
Practice Address - Fax:360-896-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA581710Medicaid