MEDICARE: MS. PRISCILLA DENISE WILLIAMS OWNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1609195445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PRISCILLA DENISE WILLIAMS OWNER

Provider Business Mailing Address
First Line	:	1552 S FOUNTAIN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-3162
Country	:	US
Telephone Number	:	937-460-8871
Fax Number	:	937-717-9192

Provider Business Practice Location Address
First Line	:	1552 S FOUNTAIN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-3162
Country	:	US
Telephone Number	:	937-460-8871
Fax Number	:	937-717-9192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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