Provider Demographics
NPI:1346303724
Name:RICE HOME MEDICAL, LLC
Entity Type:Organization
Organization Name:RICE HOME MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-235-8434
Mailing Address - Street 1:1804 SOUTH BROADWAY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2377
Mailing Address - Country:US
Mailing Address - Phone:320-762-2439
Mailing Address - Fax:320-762-2622
Practice Address - Street 1:1804 SOUTH BROADWAY
Practice Address - Street 2:SUITE 160
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2377
Practice Address - Country:US
Practice Address - Phone:320-762-2439
Practice Address - Fax:320-762-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332B00000X, 332BC3200X, 332BN1400X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN773325900Medicaid
MN773325900Medicaid