Provider Demographics
NPI:1114648995
Name:A THRIVING PLACE LLC
Entity Type:Organization
Organization Name:A THRIVING PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-929-0324
Mailing Address - Street 1:3274 BRIGGS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2502
Mailing Address - Country:US
Mailing Address - Phone:734-686-0571
Mailing Address - Fax:
Practice Address - Street 1:3274 BRIGGS BLVD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2502
Practice Address - Country:US
Practice Address - Phone:734-686-0571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty