Provider Demographics
NPI:1730384470
Name:A PLUS WILLIAMSON CARE NETWORK, LLC
Entity type:Organization
Organization Name:A PLUS WILLIAMSON CARE NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONACA
Authorized Official - Middle Name:MAYE
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:QDDP
Authorized Official - Phone:336-558-3749
Mailing Address - Street 1:PO BOX 16184
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-0184
Mailing Address - Country:US
Mailing Address - Phone:336-558-3749
Mailing Address - Fax:336-272-1273
Practice Address - Street 1:1515 W CORNWALLIS DR STE G105
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-6334
Practice Address - Country:US
Practice Address - Phone:336-558-3749
Practice Address - Fax:336-272-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408480Medicaid