Provider Demographics
NPI:1043335029
Name:THATCHER BROOK HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:THATCHER BROOK HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-546-4368
Mailing Address - Street 1:360 S STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1892
Mailing Address - Country:US
Mailing Address - Phone:801-546-4368
Mailing Address - Fax:801-546-1053
Practice Address - Street 1:1133 N MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4800
Practice Address - Country:US
Practice Address - Phone:801-546-4368
Practice Address - Fax:801-546-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1043335029Medicaid
UT467240Medicare Oscar/Certification