Provider Demographics
NPI:1184858847
Name:HC WATSON
Entity Type:Organization
Organization Name:HC WATSON
Other - Org Name:INTERIM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL AREA MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-775-3366
Mailing Address - Street 1:72 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-775-3366
Mailing Address - Fax:207-775-6299
Practice Address - Street 1:72 ATLANTIC PL
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2316
Practice Address - Country:US
Practice Address - Phone:207-775-3366
Practice Address - Fax:207-775-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2948251E00000X
ME02929251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME162680000Medicaid
ME207031Medicare PIN