Basic Information
Provider Information
NPI: 1245280080
EntityType: 2
ReplacementNPI:  
OrganizationName: RICE MEMORIAL HOSPITAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: RICE CARE CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1801 WILLMAR AVE SW
Address2:  
City: WILLMAR
State: MN
PostalCode: 562012882
CountryCode: US
TelephoneNumber: 3202142700
FaxNumber: 3202142765
Practice Location
Address1: 1801 WILLMAR AVE SW
Address2:  
City: WILLMAR
State: MN
PostalCode: 562012882
CountryCode: US
TelephoneNumber: 3202142700
FaxNumber: 3202142765
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 05/03/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FENSKE
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 3202314009
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X330432MNY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
58521960005MN MEDICAID
101545001 PREFERRED ONE PROVIDEROTHER
71-1184001 MEDICA PROVIDER NUMBEROTHER
8659CH01 BLUE CROSS OF MINNESOTAOTHER
NH021401 UCARE PROVIDER NUMBEROTHER


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