Provider Demographics
NPI:1548868417
Name:WILLIAMS COMMUNITY CARE HOME
Entity type:Organization
Organization Name:WILLIAMS COMMUNITY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-730-4764
Mailing Address - Street 1:8435 MONTICELLO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9473
Mailing Address - Country:US
Mailing Address - Phone:803-730-4764
Mailing Address - Fax:803-783-3044
Practice Address - Street 1:7705 RICHARD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3733
Practice Address - Country:US
Practice Address - Phone:803-783-1223
Practice Address - Fax:803-783-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home