MEDICARE: JACINTA R WILLIAMS

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	251B00000X	Case Management Agency		OH

General Provider Information

NPI Number	:	1104574508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACINTA R WILLIAMS

Provider Business Mailing Address
First Line	:	1735 SAWGRASS DR
Second Line	:
City	:	GREEN
State	:	OH
Zip	:	44685-7846
Country	:	US
Telephone Number	:	419-571-5898
Fax Number	:

Provider Business Practice Location Address
First Line	:	3094 W MARKET ST STE 343
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3618
Country	:	US
Telephone Number	:	234-334-5589
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	01/13/2026

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