Provider Demographics
NPI:1053156067
Name:WILLIAMS, ELAINA RACHEL
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:RACHEL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:RACHEL
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:OH
Mailing Address - Zip Code:45862-9721
Mailing Address - Country:US
Mailing Address - Phone:419-584-6207
Mailing Address - Fax:
Practice Address - Street 1:325 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:OH
Practice Address - Zip Code:45862-9721
Practice Address - Country:US
Practice Address - Phone:419-584-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTH395296253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care