Healthcare Provider Details

I. General information

NPI: 1982518072
Provider Name (Legal Business Name): THR1VE ORGANICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 E 200TH ST
EUCLID OH
44119-2504
US

IV. Provider business mailing address

1558 E 248TH ST
EUCLID OH
44117-1236
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-0435
  • Fax:
Mailing address:
  • Phone: 216-507-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMIKA HENDERSON
Title or Position: OWNER
Credential: CNA
Phone: 216-507-0002