Provider Demographics
NPI:1083779243
Name:MAISON DE WILLIAMS, INC.
Entity Type:Organization
Organization Name:MAISON DE WILLIAMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-332-5329
Mailing Address - Street 1:828 LATIOLAIS DR
Mailing Address - Street 2:P.O. BOX 1267
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4235
Mailing Address - Country:US
Mailing Address - Phone:337-332-5329
Mailing Address - Fax:337-332-5331
Practice Address - Street 1:828 LATIOLAIS DR
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4235
Practice Address - Country:US
Practice Address - Phone:337-332-5329
Practice Address - Fax:337-332-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2675261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1557943Medicaid