Organization
RAINBOW 66 STOREHOUSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMMIE C. JOHNSON (ADMINISTRATOR)
(910) 276-0766
Entity
Organization
Contact information
Practice address
706 RIGSBEE AVE, DURHAM, NC 27701-2139
(919) 686-0165
(919) 686-0167
Mailing address
525 ATKINSON ST, LAURINBURG, NC 28352-3715
(910) 276-0766
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
MHL-032-053
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418378
—
NC
Enumeration date
05/13/2009
Last updated
01/09/2017
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