Organization
RAINBOW 66 STOREHOUSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMMIE JOHNSON (PRESIDENT)
(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
3747P1801X
Personal Care Attendant
Primary
HC2475
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409455
—
NC
05
—
3418378
—
NC
05
—
6601037
—
NC
05
—
8302212
—
NC
Enumeration date
12/31/2009
Last updated
08/25/2022
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