# RAINBOW 66 STOREHOUSE INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952637878
- **Authorized official:** MRS. KIMMIE C. JOHNSON (ADMINISTRATOR)
- **Authorized official phone:** (910) 361-4398

## Contact information

- **Practice address:** 1225 S CALEDONIA RD, LAURINBURG, NC 28352-4849
- **Practice address phone:** (910) 361-4398
- **Practice address fax:** (910) 361-4510
- **Mailing address:** 1225 S CALEDONIA RD, LAURINBURG, NC 28352-4849
- **Mailing address phone:** (910) 361-4398
- **Mailing address fax:** (910) 361-4510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 3747P1801X | Personal Care Attendant | MHL-032-053 | NC | — |

## Other

- **Enumeration date:** 10/28/2009
- **Last updated:** 08/25/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3409455 | — | NC |
| 05 | — | 3418378 | — | NC |
| 05 | — | 6601037 | — | NC |
| 05 | — | 8302212 | — | NC |