Provider Demographics
NPI:1053854265
Name:THRIVE REHABILITATION LLC
Entity Type:Organization
Organization Name:THRIVE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PREVITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-733-3885
Mailing Address - Street 1:555 W 14 MILE RD STE B2
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-3100
Mailing Address - Country:US
Mailing Address - Phone:248-733-3885
Mailing Address - Fax:248-566-0098
Practice Address - Street 1:555 W 14 MILE RD STE B2
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-3100
Practice Address - Country:US
Practice Address - Phone:248-733-3885
Practice Address - Fax:248-566-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053854265Medicaid