MEDICARE: THATCHER BROOK HOME HEALTH CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043335029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THATCHER BROOK HOME HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	360 S STATE ST
Second Line	:	SUITE B
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-1892
Country	:	US
Telephone Number	:	801-546-4368
Fax Number	:	801-546-1053

Provider Business Practice Location Address
First Line	:	1133 N MAIN ST
Second Line	:	SUITE 100
City	:	LAYTON
State	:	UT
Zip	:	84041-4800
Country	:	US
Telephone Number	:	801-546-4368
Fax Number	:	801-546-1053

Authorized Official
Title or Position	:	OWNER
Name	:	DEVEN B PETTIT
Credential	:
Telephone Number	:	801-546-4368

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	10/15/2008

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