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Organization
RAINBOW 66 STOREHOUSE INC.
Active
Organization
RAINBOW 66 STOREHOUSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMMIE C. JOHNSON (ADMINISTRATOR)
(910) 361-4398
Entity
Organization
Contact information
Practice address
1225 S CALEDONIA RD, LAURINBURG, NC 28352-4849
(910) 361-4398
(910) 361-4510
Mailing address
1225 S CALEDONIA RD, LAURINBURG, NC 28352-4849
(910) 361-4398
(910) 361-4510
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
3747P1801X
Personal Care Attendant
MHL-032-053
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409455
—
NC
05
—
3418378
—
NC
05
—
6601037
—
NC
05
—
8302212
—
NC
Enumeration date
10/28/2009
Last updated
08/25/2022
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