Provider Demographics
NPI:1285512830
Name:THRIVE PROSTHETICS
Entity type:Organization
Organization Name:THRIVE PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:916-671-3417
Mailing Address - Street 1:6620 COYLE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6337
Mailing Address - Country:US
Mailing Address - Phone:916-995-5680
Mailing Address - Fax:
Practice Address - Street 1:138 JOERSCHKE DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5248
Practice Address - Country:US
Practice Address - Phone:530-477-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE PROSTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier