Provider Demographics
NPI:1073908679
Name:R&N ADULT DAYCARE II
Entity Type:Organization
Organization Name:R&N ADULT DAYCARE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SENTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-379-5557
Mailing Address - Street 1:110 E SOUTH ST
Mailing Address - Street 2:P.O. BOX 351
Mailing Address - City:HOLLANDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38748-3834
Mailing Address - Country:US
Mailing Address - Phone:662-807-5049
Mailing Address - Fax:
Practice Address - Street 1:110 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:MS
Practice Address - Zip Code:38748-3834
Practice Address - Country:US
Practice Address - Phone:662-807-5049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========Medicaid