Provider Demographics
NPI:1730302837
Name:RICE HOME
Entity Type:Organization
Organization Name:RICE HOME
Other - Org Name:RICE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLOE RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-239-9311
Mailing Address - Street 1:895 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7051
Mailing Address - Country:US
Mailing Address - Phone:314-837-6336
Mailing Address - Fax:314-839-4044
Practice Address - Street 1:895 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7051
Practice Address - Country:US
Practice Address - Phone:314-837-6336
Practice Address - Fax:314-839-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO63659877320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities