Healthcare Provider Details

I. General information

NPI: 1164074340
Provider Name (Legal Business Name): THRIVE CENTER FOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 PARCHMENT DR SE STE 105
GRAND RAPIDS MI
49546-2377
US

IV. Provider business mailing address

847 PARCHMENT DR SE STE 105
GRAND RAPIDS MI
49546-2377
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3350
  • Fax:
Mailing address:
  • Phone: 616-805-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL AGNES JUGAN
Title or Position: OWNER
Credential: MD
Phone: 616-805-3350