=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891011789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WATSON HEALTH SYSTEM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2010
-----------------------------------------------------
Last Update Date | 04/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2732 DESTREHAN AVE C
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-6443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-287-3495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2732 DESTREHAN AVE C
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-6443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CHRISTOPHER CODY WATSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-287-3495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------