MEDICARE: PETERSONS HOME CARE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BC3200X	Customized Equipment (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	335E00000X	Prosthetic/Orthotic Supplier
5	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1043290885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSONS HOME CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 27968
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0968
Country	:	US
Telephone Number	:	570-966-8030
Fax Number	:	570-966-8040

Provider Business Practice Location Address
First Line	:	1991 INDUSTRIAL BLVD STE 101
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-3615
Country	:	US
Telephone Number	:	928-669-8285
Fax Number	:	928-669-5330

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. ROBIN L MENCHEN
Credential	:
Telephone Number	:	407-822-4600

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	06/10/2024

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Directions to “PETERSONS HOME CARE INC ” Practice Location

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