Provider Demographics
NPI:1013558659
Name:WILLIAMS, ELEANOR C
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SUNRISE AVE STE A16
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4541
Mailing Address - Country:US
Mailing Address - Phone:916-742-1110
Mailing Address - Fax:
Practice Address - Street 1:901 SUNRISE AVE STE A16
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4541
Practice Address - Country:US
Practice Address - Phone:916-742-1110
Practice Address - Fax:916-749-3279
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344700055251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health