Provider Demographics
NPI:1053693598
Name:RAINBOW TRANSPORT SERVICE, LLC
Entity type:Organization
Organization Name:RAINBOW TRANSPORT SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:928-757-7608
Mailing Address - Street 1:7644 E MONTE TESORO DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-9786
Mailing Address - Country:US
Mailing Address - Phone:928-757-7608
Mailing Address - Fax:928-757-7608
Practice Address - Street 1:7644 E MONTE TESORO DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-9786
Practice Address - Country:US
Practice Address - Phone:928-757-7608
Practice Address - Fax:928-757-7608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAINBOW TRANSPORT SERVICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL16106849343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)