1003089913 NPI number — PEGGY P. WILLIAMS

Table of content: (NPI 1003089913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003089913 NPI number — PEGGY P. WILLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEGGY P. WILLIAMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRICE FAMILY CARE HOME
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003089913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27846-0021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-792-1993
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1385 BROWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27846-9512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-792-1993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
252-792-1993

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  FCL058-004 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: FCL058-001 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7802790 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".