Provider Demographics
NPI:1790904522
Name:MAISON DE WILLIAMS, INC PCS
Entity Type:Organization
Organization Name:MAISON DE WILLIAMS, INC PCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-507-3916
Mailing Address - Street 1:828 LATIOLAIS DR
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4235
Mailing Address - Country:US
Mailing Address - Phone:337-332-5331
Mailing Address - Fax:
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:337-332-5331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9653171W00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171W00000XOther Service ProvidersContractorGroup - Single Specialty
Not Answered251G00000XAgenciesHospice Care, Community Based