Williams Group Home, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL071-020 Issued in NC

Legal business name

WILLIAMS GROUP HOME, INC.

Practice address

2161 New Rd
Burgaw, NC 28425-3143

Phone

(910) 259-7677

Fax

(910) 259-6009

NPI assigned

Dec 8, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Amy Monroe, BACHELOR OF ARTS

Title

Director

Phone

(910) 259-7677

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396805735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 696",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284250696",
            "telephone_number": "910-259-7677",
            "fax_number": "910-259-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2161 NEW RD",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284253143",
            "telephone_number": "910-259-7677",
            "fax_number": "910-259-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMS GROUP HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONROE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-259-7677",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BACHELOR OF ARTS"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL071-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603788",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Burgaw, NC
• Providers in Burgaw, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.