Provider Demographics
NPI:1225501455
Name:THE CARTER WILLIAMS GROUP, LLC
Entity Type:Organization
Organization Name:THE CARTER WILLIAMS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:708-595-7542
Mailing Address - Street 1:5209 HOHMAN AVE STE 3011
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1719
Mailing Address - Country:US
Mailing Address - Phone:833-422-7837
Mailing Address - Fax:
Practice Address - Street 1:5209 HOHMAN AVE STE 3011
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1719
Practice Address - Country:US
Practice Address - Phone:833-422-7837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18-014317OtherINDIANA STATE DEPARTMENT OF HEALTH