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General NPI Number Information
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NPI Number | 1942504386
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Entity Type | Organization
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Legal Business Name | THRIVE WELLNESS CORP
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 109 SOUNDVIEW TER
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City | NORTHPORT
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State | NY
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Zip | 11768-1231
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Country | US
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Telephone | 631-766-2417
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Fax |
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Provider Business Mailing Address
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Address Line | 109 SOUNDVIEW TER
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City | NORTHPORT
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State | NY
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Zip | 11768-1231
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Country | US
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Telephone | 631-766-2417
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT HEPPENHEIMER
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Credential |
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Telephone | 631-766-2417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | NULL
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