Provider Demographics
NPI:1356424832
Name:WILLIAMS COMMUNITY LIVING, INC.
Entity type:Organization
Organization Name:WILLIAMS COMMUNITY LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS-DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-837-0043
Mailing Address - Street 1:2662 WEST GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208
Mailing Address - Country:US
Mailing Address - Phone:313-871-7452
Mailing Address - Fax:313-837-0043
Practice Address - Street 1:2662 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1237
Practice Address - Country:US
Practice Address - Phone:313-871-7542
Practice Address - Fax:313-837-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL820007539320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAL820007539OtherSTATE LICENSE NUMBER