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General NPI Number Information
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NPI Number | 1285454934
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Entity Type | Organization
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Legal Business Name | THRIVE GR LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 5565 BROADMOOR AVE SE # DOORR
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City | KENTWOOD
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State | MI
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Zip | 49512-5302
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Country | US
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Telephone | 225-620-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 5432 ADA DR SE
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City | ADA
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State | MI
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Zip | 49301-7822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH WILLIAMS
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Credential | NP
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Telephone | 225-620-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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