Provider Demographics
NPI:1962955641
Name:GODFREY, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GODFREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 S HIGHLAND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12725 SW 66TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-2546
Practice Address - Country:US
Practice Address - Phone:503-430-7699
Practice Address - Fax:503-430-8374
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based