Provider Demographics
NPI:1215590948
Name:C. L. WILLIAMS ENTERPRISES, INC.
Entity Type:Organization
Organization Name:C. L. WILLIAMS ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-971-5000
Mailing Address - Street 1:2355 E STADIUM BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4800
Mailing Address - Country:US
Mailing Address - Phone:734-971-5000
Mailing Address - Fax:
Practice Address - Street 1:2355 E STADIUM BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4800
Practice Address - Country:US
Practice Address - Phone:734-971-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800730616OtherSTATE OF MICHIGAN LARA