- Enrollment id
- O20051123000145
- Enrollment state
- OK
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1942287339
- Multiple npi flag
- N
- Ccn
- 377694
- Associate id
- 6406876259
- Organization name
- MDR HEALTH GROUP LLC
- Doing business as name
- RAINBOW HOME HEALTH
- Incorporation date
- 2005-08-02
- Incorporation state
- OK
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1425 E LINCOLN RD
- Address line 2
- STE A2
- City
- IDABEL
- State
- OK
- Zip code
- 747457345
- Practice location type
- HHA BRANCH