Provider Demographics
NPI:1174626147
Name:INTERIM HEALTHCARE
Entity type:Organization
Organization Name:INTERIM HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISIONAL DIRECTOR HOME CARE SERV
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-777-9090
Mailing Address - Street 1:200 LEDGEWOOD PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1068
Mailing Address - Country:US
Mailing Address - Phone:781-261-9616
Mailing Address - Fax:781-261-9632
Practice Address - Street 1:200 LEDGEWOOD PL
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1068
Practice Address - Country:US
Practice Address - Phone:781-261-9616
Practice Address - Fax:781-261-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7070251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0603201Medicaid
MA227215Medicare ID - Type Unspecified