Provider Demographics
NPI:1730307406
Name:WILLIAMS CARE FACILITIES
Entity type:Organization
Organization Name:WILLIAMS CARE FACILITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-593-4462
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:MO
Mailing Address - Zip Code:63943-0057
Mailing Address - Country:US
Mailing Address - Phone:573-593-4462
Mailing Address - Fax:573-593-4510
Practice Address - Street 1:21 & O HWY
Practice Address - Street 2:
Practice Address - City:GRANDIN
Practice Address - State:MO
Practice Address - Zip Code:63943
Practice Address - Country:US
Practice Address - Phone:573-593-4462
Practice Address - Fax:573-593-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032922310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility