Provider Demographics
NPI:1851454227
Name:RICE HOME MEDICAL, LLC
Entity Type:Organization
Organization Name:RICE HOME MEDICAL, LLC
Other - Org Name:CORNER HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BAGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-540-6119
Mailing Address - Street 1:2730 NEVADA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2807
Mailing Address - Country:US
Mailing Address - Phone:763-535-5335
Mailing Address - Fax:763-536-3590
Practice Address - Street 1:1020 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1806
Practice Address - Country:US
Practice Address - Phone:507-637-2330
Practice Address - Fax:507-637-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-02-28
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
MN0286140005Medicare ID - Type UnspecifiedREDWOOD FALLS BRANCH