Provider Demographics
NPI:1003089913
Name:PEGGY P. WILLIAMS
Entity Type:Organization
Organization Name:PEGGY P. WILLIAMS
Other - Org Name:PRICE FAMILY CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-792-1993
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27846-0021
Mailing Address - Country:US
Mailing Address - Phone:252-792-1993
Mailing Address - Fax:
Practice Address - Street 1:1385 BROWN RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27846-9512
Practice Address - Country:US
Practice Address - Phone:252-792-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL058-004310400000X
NCFCL058-001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802790Medicaid