Provider Demographics
NPI:1508656943
Name:WATSON HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:WATSON HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:EDWINA
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA, PHLEBOTOMIST
Authorized Official - Phone:980-451-6449
Mailing Address - Street 1:1800 BEACON RIDGE RD APT 315
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3565
Mailing Address - Country:US
Mailing Address - Phone:980-451-6449
Mailing Address - Fax:
Practice Address - Street 1:1808 RUSH WIND DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2307
Practice Address - Country:US
Practice Address - Phone:794-649-6919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health