Provider Demographics
NPI:1841409836
Name:WILLIAMS, INC.
Entity Type:Organization
Organization Name:WILLIAMS, INC.
Other - Org Name:PILLSBURY BOARD AND CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-808-0413
Mailing Address - Street 1:12004 COUNTY ROAD 11
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3016
Mailing Address - Country:US
Mailing Address - Phone:952-808-0413
Mailing Address - Fax:
Practice Address - Street 1:2500 PILLSBURY AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4201
Practice Address - Country:US
Practice Address - Phone:612-872-8363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00173313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility