MEDICARE: THUNDER BAY HOME CARE SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1417892613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THUNDER BAY HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	624 W LAKE ST
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1838
Country	:	US
Telephone Number	:	989-464-3087
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 W LAKE ST
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1838
Country	:	US
Telephone Number	:	989-464-3087
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRYDIE MAY MOLDENHAUER
Credential	:
Telephone Number	:	989-464-3087

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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Directions to “THUNDER BAY HOME CARE SERVICES LLC ” Practice Location

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