Provider Demographics
NPI:1942504386
Name:THRIVE WELLNESS CORP
Entity Type:Organization
Organization Name:THRIVE WELLNESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-766-2417
Mailing Address - Street 1:109 SOUNDVIEW TER
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1231
Mailing Address - Country:US
Mailing Address - Phone:631-766-2417
Mailing Address - Fax:
Practice Address - Street 1:109 SOUNDVIEW TER
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1231
Practice Address - Country:US
Practice Address - Phone:631-766-2417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care