Provider Demographics
NPI:1063895506
Name:WILLIAMS, JAMES (MSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10204 BODE ST STE B
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9813
Mailing Address - Country:US
Mailing Address - Phone:855-241-7160
Mailing Address - Fax:954-324-8354
Practice Address - Street 1:10204 BODE ST STE B
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9813
Practice Address - Country:US
Practice Address - Phone:855-241-7160
Practice Address - Fax:954-324-8354
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8954H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility