MEDICARE: ITHRIVE HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1144508615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITHRIVE HEALTH LLC

Provider Business Mailing Address
First Line	:	2951 MARINA BAY DR
Second Line	:	130-542
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2735
Country	:	US
Telephone Number	:	888-982-8539
Fax Number	:	888-982-8539

Provider Business Practice Location Address
First Line	:	6009 RICHMOND AVE
Second Line	:	SUITE 115
City	:	HOUSTON
State	:	TX
Zip	:	77057-6226
Country	:	US
Telephone Number	:	888-982-8539
Fax Number	:	888-982-8539

Authorized Official
Title or Position	:	OWNER
Name	:	GREG RAINBOLT
Credential	:
Telephone Number	:	888-982-8539

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	04/23/2014

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Directions to “ITHRIVE HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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