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General NPI Number Information
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NPI Number | 1790804417
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Entity Type | Organization
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Legal Business Name | STELLAM WILLIAMSON
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 426 N MAIN ST
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City | BURLINGTON
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State | NC
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Zip | 27217-3908
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Country | US
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Telephone | 336-227-0742
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Fax | 336-227-0742
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Provider Business Mailing Address
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Address Line | 203 N MAIN ST STE 315
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City | ROXBORO
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State | NC
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Zip | 27573-5343
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Country | US
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Telephone | 336-599-0375
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. STELLA B WILLIAMSON
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Credential |
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Telephone | 336-227-0742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | FCL-001-063
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License Number State | NC
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