Healthcare Provider Details

I. General information

NPI: 1407391493
Provider Name (Legal Business Name): THRIVING SENIORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 MASON STREET STE 109
VACAVILLE CA
95688
US

IV. Provider business mailing address

479 MASON STREET STE 109
VACAVILLE CA
95688
US

V. Phone/Fax

Practice location:
  • Phone: 707-317-1740
  • Fax: 707-471-4028
Mailing address:
  • Phone: 707-317-1740
  • Fax: 707-471-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number484700010
License Number StateCA

VIII. Authorized Official

Name: REBECCA SMITH
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 707-317-1740