MEDICARE: TERRANCE ALFONSO WILLIAMS JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		NV

General Provider Information

NPI Number	:	1053663450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE ALFONSO WILLIAMS JR.

Provider Business Mailing Address
First Line	:	5317 WEST RED BERRY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7943
Country	:	US
Telephone Number	:	702-371-7970
Fax Number	:

Provider Business Practice Location Address
First Line	:	5317 REDBERRY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4019
Country	:	US
Telephone Number	:	702-371-7970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	12/09/2025

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