Healthcare Provider Details

I. General information

NPI: 1447448824
Provider Name (Legal Business Name): JUANITA ANN WILLIAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MILES WEST HWY 77 @ MP31 9 MILES WEST HWY 77 @ MP31
INDIAN WELLS AZ
86031
US

IV. Provider business mailing address

PO BOX 3368
INDIAN WELLS AZ
86031-3368
US

V. Phone/Fax

Practice location:
  • Phone: 928-856-9247
  • Fax:
Mailing address:
  • Phone: 928-856-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JUANITA ANN WILLIAMS
Title or Position: CEO/PERSONAL CARE ATTENDANT
Credential:
Phone: 928-856-9247