Healthcare Provider Details

I. General information

NPI: 1083779243
Provider Name (Legal Business Name): MAISON DE WILLIAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
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 P.O. BOX 1267
BREAUX BRIDGE LA
70517-4235
US

V. Phone/Fax

Practice location:
  • Phone: 337-332-5329
  • Fax: 337-332-5331
Mailing address:
  • Phone: 337-332-5329
  • Fax: 337-332-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number2675
License Number StateLA

VIII. Authorized Official

Name: CHERYL W WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 337-332-5329