=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164316378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANDRA L WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2025
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 UNION HIGH DR
-----------------------------------------------------
City | BELTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29627-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-603-8824
-----------------------------------------------------
Fax | 864-900-4705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 MANSION CIR
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673-7850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-603-8824
-----------------------------------------------------
Fax | 864-900-4705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------