MEDICARE: THRIVVE 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619799699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVVE LLC

Provider Business Mailing Address
First Line	:	15430 FOUNDERS LN APT 108
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-6174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15430 FOUNDERS LN APT 108
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-6174
Country	:	US
Telephone Number	:	619-727-0728
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AHMED MOHAMED BAHSANE
Credential	:
Telephone Number	:	619-727-0728

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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