Healthcare Provider Details

I. General information

NPI: 1932958626
Provider Name (Legal Business Name): THRIVE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N UNIT 210A
NEW HOPE MN
55427-1235
US

IV. Provider business mailing address

4124 QUEBEC AVE N UNIT 210A
NEW HOPE MN
55427-1235
US

V. Phone/Fax

Practice location:
  • Phone: 612-806-1480
  • Fax:
Mailing address:
  • Phone: 612-806-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDIRASHID ODHOWA
Title or Position: OWNER
Credential:
Phone: 612-806-1480