Healthcare Provider Details

I. General information

NPI: 1790904522
Provider Name (Legal Business Name): MAISON DE WILLIAMS, INC PCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 LATIOLAIS DR
BREAUX BRIDGE LA
70517-4235
US

IV. Provider business mailing address

828 LATIOLAIS DR
BREAUX BRIDGE LA
70517-4235
US

V. Phone/Fax

Practice location:
  • Phone: 337-332-5331
  • Fax:
Mailing address:
  • Phone: 337-332-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number9653
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number9653
License Number StateLA

VIII. Authorized Official

Name: MR. GEORGE J WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 337-507-3916