Healthcare Provider Details

I. General information

NPI: 1942504386
Provider Name (Legal Business Name): THRIVE WELLNESS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SOUNDVIEW TER
NORTHPORT NY
11768-1231
US

IV. Provider business mailing address

109 SOUNDVIEW TER
NORTHPORT NY
11768-1231
US

V. Phone/Fax

Practice location:
  • Phone: 631-766-2417
  • Fax:
Mailing address:
  • Phone: 631-766-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ROBERT HEPPENHEIMER
Title or Position: PRESIDENT
Credential:
Phone: 631-766-2417