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General NPI Number Information
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NPI Number | 1194294991
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Entity Type | Organization
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Legal Business Name | BRAD RICE LLC
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Dates
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Enumeration Date | 11/21/2018
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 22881 N 103RD LN
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City | PEORIA
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State | AZ
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Zip | 85383-2757
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Country | US
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Telephone | 847-890-5703
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Fax | 833-815-2428
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Provider Business Mailing Address
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Address Line | 22881 N 103RD LN
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City | PEORIA
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State | AZ
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Zip | 85383-2757
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Country | US
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Telephone | 847-890-5703
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Fax | 833-815-2428
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. BRADLEY DAVID RICE JR.
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Credential | MS CCC-SLP
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Telephone | 847-890-5703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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