MEDICARE: JACIE JO RICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1083588099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACIE JO RICE

Provider Business Mailing Address
First Line	:	1845 6TH RD
Second Line	:
City	:	SAINT LIBORY
State	:	NE
Zip	:	68872-2915
Country	:	US
Telephone Number	:	308-947-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 6TH RD
Second Line	:
City	:	SAINT LIBORY
State	:	NE
Zip	:	68872-2915
Country	:	US
Telephone Number	:	308-947-0010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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Directions to “ JACIE JO RICE ” Practice Location

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