1174231518 NPI number — THRIVING WITHIN LLC

Table of content: (NPI 1174231518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174231518 NPI number — THRIVING WITHIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIVING WITHIN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174231518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 ARCTIC BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99503-4579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-268-4234
Provider Business Mailing Address Fax Number:
877-907-0952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 N ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99501-3285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-268-4234
Provider Business Practice Location Address Fax Number:
877-907-0952
Provider Enumeration Date:
11/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MICHAEL
Authorized Official First Name:
ELI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-268-4234

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1737553 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com