Healthcare Provider Details

I. General information

NPI: 1093956146
Provider Name (Legal Business Name): PRK WILLIAMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 40TH ST NE
CEDAR RAPIDS IA
52402-5613
US

IV. Provider business mailing address

139 40TH ST NE
CEDAR RAPIDS IA
52402-5613
US

V. Phone/Fax

Practice location:
  • Phone: 319-826-6068
  • Fax: 866-397-3834
Mailing address:
  • Phone: 319-826-6068
  • Fax: 866-397-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 303-241-8181