Provider Demographics
NPI:1194294991
Name:BRAD RICE LLC
Entity type:Organization
Organization Name:BRAD RICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:847-890-5703
Mailing Address - Street 1:22881 N 103RD LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2757
Mailing Address - Country:US
Mailing Address - Phone:847-890-5703
Mailing Address - Fax:833-815-2428
Practice Address - Street 1:22881 N 103RD LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2757
Practice Address - Country:US
Practice Address - Phone:847-890-5703
Practice Address - Fax:833-815-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1861751653Medicaid