Provider Demographics
NPI:1427756881
Name:WILLIAMS, ARIES N
Entity type:Individual
Prefix:
First Name:ARIES
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17406 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2233
Mailing Address - Country:US
Mailing Address - Phone:623-224-0400
Mailing Address - Fax:623-321-8570
Practice Address - Street 1:17575 W EVANS DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-7755
Practice Address - Country:US
Practice Address - Phone:623-225-2887
Practice Address - Fax:623-321-8570
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11979H310400000X
AZAL9563H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility