MEDICARE: R S ENTERPRISE

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	311ZA0620X	Adult Care Home Facility	311ZA0620X	MS

General Provider Information

NPI Number	:	1164845210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R S ENTERPRISE

Provider Business Mailing Address
First Line	:	532 BURNS ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39203-3601
Country	:	US
Telephone Number	:	601-960-7426
Fax Number	:	601-960-7426

Provider Business Practice Location Address
First Line	:	532 BURNS ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39203-3601
Country	:	US
Telephone Number	:	601-960-7426
Fax Number	:	601-960-7426

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT EARL SILAS
Credential	:	N/A
Telephone Number	:	601-960-7426

Provider Enumeration Date	:	01/26/2014
Last Update Date	:	01/26/2014

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Directions to “R S ENTERPRISE ” Practice Location

Language	Start Address	Practice Location

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