52D1047368 CLIA NUMBER - RAINBOW HOUSE

Laboratory Demographics

CLIA Number: 52D1047368

Facility Name: RAINBOW HOUSE

Facility Address:
3100 SOUTHBROOK CT
MANITOWOC, WI
ZIP 54220
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Facility Phone Number: 920 684-4851

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1720122690

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	52D1047368
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	RAINBOW HOUSE
Street	3100 SOUTHBROOK CT
City	MANITOWOC
State	WI
ZIP	54220
Phone	920 684-4851
CertificateType	4
CertificateEffectiveDate	11/2/2023
CertificateExpirationDate	11/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024