Healthcare Provider Details

I. General information

NPI: 1801882949
Provider Name (Legal Business Name): WILLIAMSTON HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SANTREE DR
WILLIAMSTON NC
27892-1466
US

IV. Provider business mailing address

160 SANTREE DR
WILLIAMSTON NC
27892-1466
US

V. Phone/Fax

Practice location:
  • Phone: 252-792-6969
  • Fax: 252-792-6785
Mailing address:
  • Phone: 252-792-6969
  • Fax: 252-792-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL058006
License Number StateNC

VIII. Authorized Official

Name: MRS. TINA A HALLMAN
Title or Position: CONTROLLER
Credential:
Phone: 828-324-8898