Provider Demographics
NPI:1154644342
Name:ROSHAUN WILLIAMS
Entity Type:Organization
Organization Name:ROSHAUN WILLIAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHAUN
Authorized Official - Middle Name:ANJALI
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-949-7497
Mailing Address - Street 1:4012 GUESS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1510
Mailing Address - Country:US
Mailing Address - Phone:919-949-7497
Mailing Address - Fax:
Practice Address - Street 1:4012 GUESS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1510
Practice Address - Country:US
Practice Address - Phone:919-949-7497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL032516261QM0850X
311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health