Healthcare Provider Details

I. General information

NPI: 1013544782
Provider Name (Legal Business Name): WILLIAMS FAMILY VETERAN CARE SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 WOODBERRY LAKE DR
GREENSBORO NC
27455-0944
US

IV. Provider business mailing address

3902 WOODBERRY LAKE DR
GREENSBORO NC
27455-0944
US

V. Phone/Fax

Practice location:
  • Phone: 336-303-2778
  • Fax:
Mailing address:
  • Phone: 336-303-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: LATINA WILLIAMS
Title or Position: SECRETARY
Credential:
Phone: 336-303-2778