Provider Demographics
NPI:1306060967
Name:MAISON DE WILLIAMS, INC
Entity type:Organization
Organization Name:MAISON DE WILLIAMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-332-5329
Mailing Address - Street 1:828 LATIOLAIS DR
Mailing Address - Street 2:P.O. BOX 1267
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4235
Mailing Address - Country:US
Mailing Address - Phone:337-332-5329
Mailing Address - Fax:337-332-5331
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:337-332-5329
Practice Address - Fax:337-332-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2675251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care