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General NPI Number Information
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NPI Number | 1356424832
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Entity Type | Organization
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Legal Business Name | WILLIAMS COMMUNITY LIVING, INC.
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 2662 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48208-1237
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Country | US
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Telephone | 313-871-7542
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Fax | 313-837-0043
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Provider Business Mailing Address
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Address Line | 2662 WEST GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48208
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Country | US
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Telephone | 313-871-7452
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Fax | 313-837-0043
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. SANDRA L WILLIAMS-DAWSON
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Credential |
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Telephone | 313-837-0043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | AL820007539
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License Number State | MI
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