MEDICARE: ROUSSEAU ENTERPRISES, INC.

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	314000000X	Skilled Nursing Facility	35865	ME
2	313M00000X	Nursing Facility/Intermediate Care Facility	35865	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467446393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUSSEAU ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	29 ELM ST
Second Line	:
City	:	TOPSHAM
State	:	ME
Zip	:	04086-1423
Country	:	US
Telephone Number	:	207-725-7495
Fax Number	:	207-725-7195

Provider Business Practice Location Address
First Line	:	29 ELM ST
Second Line	:
City	:	TOPSHAM
State	:	ME
Zip	:	04086-1423
Country	:	US
Telephone Number	:	207-725-7495
Fax Number	:	207-725-7195

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MITCHELL A. ROUSSEAU
Credential	:
Telephone Number	:	207-725-4071

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	03/09/2011

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Directions to “ROUSSEAU ENTERPRISES, INC. ” Practice Location

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