Provider Demographics
NPI:1700124153
Name:THRIVE WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:THRIVE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALDIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-819-2619
Mailing Address - Street 1:1061 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4437
Mailing Address - Country:US
Mailing Address - Phone:303-819-2619
Mailing Address - Fax:
Practice Address - Street 1:5437 S PRINCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1123
Practice Address - Country:US
Practice Address - Phone:303-819-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6757261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center