Provider Demographics
NPI:1770235772
Name:360 THRIVE LLC
Entity Type:Organization
Organization Name:360 THRIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-245-7760
Mailing Address - Street 1:203 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2805
Mailing Address - Country:US
Mailing Address - Phone:508-245-7760
Mailing Address - Fax:
Practice Address - Street 1:203 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2805
Practice Address - Country:US
Practice Address - Phone:508-245-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date: