Provider Demographics
NPI:1730855073
Name:RICE, ERNEST ZACHARY JR (HOMECARE PROVIDER)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:ZACHARY
Last Name:RICE
Suffix:JR
Gender:M
Credentials:HOMECARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 VAN DYKE ST APT 413
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-4201
Mailing Address - Country:US
Mailing Address - Phone:313-329-8897
Mailing Address - Fax:
Practice Address - Street 1:1085 VAN DYKE ST APT 413
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-4201
Practice Address - Country:US
Practice Address - Phone:313-329-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MI374U000000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty