MEDICARE: SUN BROOK HOME CARE LLC

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		UT

General Provider Information

NPI Number	:	1134310139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN BROOK HOME CARE LLC

Provider Business Mailing Address
First Line	:	491 WILLIAMSON ROAD,
Second Line	:	SUITE 204
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9252
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 FASHION BLVD.
Second Line	:	SUITE 290
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6156
Country	:	US
Telephone Number	:	801-254-5722
Fax Number	:	801-446-8981

Authorized Official
Title or Position	:	SECRETARY AND GENERAL COUNSEL
Name	:	DOUGLAS J. ABELL
Credential	:
Telephone Number	:	704-664-2876

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/29/2012

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