Healthcare Provider Details

I. General information

NPI: 1235318411
Provider Name (Legal Business Name): RICE HOME MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 08/22/2024
Certification Date: 08/28/2023
Deactivation Date: 07/31/2024
Reactivation Date: 08/22/2024

III. Provider practice location address

225 7TH AVE E
ALEXANDRIA MN
56308-1831
US

IV. Provider business mailing address

2730 NEVADA AVE N
NEW HOPE MN
55427-2807
US

V. Phone/Fax

Practice location:
  • Phone: 800-637-7795
  • Fax: 320-231-4941
Mailing address:
  • Phone: 763-535-5335
  • Fax: 763-536-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMN

VIII. Authorized Official

Name: TAMMI LEE BAGSTAD
Title or Position: COMPLIANCE MANAGER
Credential: OHCC, CHCO
Phone: 763-540-6119