Provider Demographics
NPI:1336360759
Name:WILLIAMS FAMILY CARE 3
Entity Type:Organization
Organization Name:WILLIAMS FAMILY CARE 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETRULA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-761-8409
Mailing Address - Street 1:2510 GILMER AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-5159
Mailing Address - Country:US
Mailing Address - Phone:336-761-8409
Mailing Address - Fax:336-761-8409
Practice Address - Street 1:2510 GILMER AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5159
Practice Address - Country:US
Practice Address - Phone:336-761-8409
Practice Address - Fax:336-761-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility