Healthcare Provider Details

I. General information

NPI: 1548868417
Provider Name (Legal Business Name): WILLIAMS COMMUNITY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7705 RICHARD ST
COLUMBIA SC
29209-3733
US

IV. Provider business mailing address

8435 MONTICELLO RD
COLUMBIA SC
29203-9473
US

V. Phone/Fax

Practice location:
  • Phone: 803-783-1223
  • Fax: 803-783-3044
Mailing address:
  • Phone: 803-730-4764
  • Fax: 803-783-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES WILLIAMS
Title or Position: ADMINISTRATOR /OWNER
Credential:
Phone: 803-730-4764