Provider Demographics
NPI:1518359561
Name:DEYA WILLIAMS
Entity Type:Organization
Organization Name:DEYA WILLIAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:DEYA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:315-200-2468
Mailing Address - Street 1:202 HERKIMER ST
Mailing Address - Street 2:1
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1714
Mailing Address - Country:US
Mailing Address - Phone:315-200-2468
Mailing Address - Fax:
Practice Address - Street 1:202 HERKIMER ST
Practice Address - Street 2:1
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1714
Practice Address - Country:US
Practice Address - Phone:315-200-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-28
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314670-1311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home