Healthcare Provider Details

I. General information

NPI: 1285512830
Provider Name (Legal Business Name): THRIVE PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 JOERSCHKE DR
GRASS VALLEY CA
95945-5248
US

IV. Provider business mailing address

6620 COYLE AVE STE 301
CARMICHAEL CA
95608-6337
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-1004
  • Fax:
Mailing address:
  • Phone: 916-995-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KEVIN WILLIAM HENRY
Title or Position: CFO
Credential: CFO
Phone: 916-671-3417