Provider Demographics
NPI:1194470039
Name:RICE, CASSANDRA JO
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JO
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPENCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3057
Mailing Address - Country:US
Mailing Address - Phone:304-291-9066
Mailing Address - Fax:
Practice Address - Street 1:200 SPENCE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3057
Practice Address - Country:US
Practice Address - Phone:304-291-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator