Provider Demographics
NPI:1255788667
Name:THRIVE ENRICH EMPOWER LLC
Entity type:Organization
Organization Name:THRIVE ENRICH EMPOWER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STELZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-939-2550
Mailing Address - Street 1:255 SPENCER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2494
Mailing Address - Country:US
Mailing Address - Phone:636-939-2550
Mailing Address - Fax:636-939-2551
Practice Address - Street 1:255 SPENCER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2494
Practice Address - Country:US
Practice Address - Phone:636-477-6111
Practice Address - Fax:636-928-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)