Provider Demographics
NPI:1447448824
Name:JUANITA ANN WILLIAMS
Entity type:Organization
Organization Name:JUANITA ANN WILLIAMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PERSONAL CARE ATTENDANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-856-9247
Mailing Address - Street 1:PO BOX 3368
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:86031-3368
Mailing Address - Country:US
Mailing Address - Phone:928-856-9247
Mailing Address - Fax:
Practice Address - Street 1:9 MILES WEST HWY 77 @ MP31
Practice Address - Street 2:9 MILES WEST HWY 77 @ MP31
Practice Address - City:INDIAN WELLS
Practice Address - State:AZ
Practice Address - Zip Code:86031
Practice Address - Country:US
Practice Address - Phone:928-856-9247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ205836OtherAHCCCS INDEPENDENT PROVI