Healthcare Provider Details

I. General information

NPI: 1013590116
Provider Name (Legal Business Name): RICE ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 PARKER RD BUILDING C SUITE 210
CONYERS GA
30094
US

IV. Provider business mailing address

105 SYRACUSE LN
COVINGTON GA
30016-7670
US

V. Phone/Fax

Practice location:
  • Phone: 770-624-2607
  • Fax: 770-624-2607
Mailing address:
  • Phone: 678-677-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MALI RICE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 678-677-1937