Provider Demographics
NPI:1952597544
Name:RAINBOW CENTER OF MICHIGAN INC
Entity Type:Organization
Organization Name:RAINBOW CENTER OF MICHIGAN INC
Other - Org Name:RAINBOW CENTER OF MICHIGAN INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WINNIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-575-0884
Mailing Address - Street 1:14733 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9545
Mailing Address - Country:US
Mailing Address - Phone:313-575-0884
Mailing Address - Fax:313-865-1582
Practice Address - Street 1:14733 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9545
Practice Address - Country:US
Practice Address - Phone:734-234-8707
Practice Address - Fax:734-243-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5800773336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2604097Medicaid