Provider Demographics
NPI:1962669614
Name:JRS&J ADULT CARE CENTER, INC
Entity Type:Organization
Organization Name:JRS&J ADULT CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-773-8750
Mailing Address - Street 1:803 W MAIN ST
Mailing Address - Street 2:P. O. 1009
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2539
Mailing Address - Country:US
Mailing Address - Phone:662-773-8750
Mailing Address - Fax:
Practice Address - Street 1:803 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2539
Practice Address - Country:US
Practice Address - Phone:662-773-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility