MEDICARE: THISTLE CROFT 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1598541864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THISTLE CROFT LLC

Provider Business Mailing Address
First Line	:	PO BOX 214
Second Line	:
City	:	MUKILTEO
State	:	WA
Zip	:	98275-0214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 MADISON ST
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-4441
Country	:	US
Telephone Number	:	425-760-8551
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	GAVINA BAH
Credential	:
Telephone Number	:	425-760-8551

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	09/04/2023

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Directions to “THISTLE CROFT LLC ” Practice Location

Language	Start Address	Practice Location

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