Provider Demographics
NPI:1023599198
Name:THRIVE LIFE WELLNESS CENTER INC
Entity type:Organization
Organization Name:THRIVE LIFE WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:331-300-1440
Mailing Address - Street 1:246 E JANATA BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5377
Mailing Address - Country:US
Mailing Address - Phone:331-300-1440
Mailing Address - Fax:949-655-5827
Practice Address - Street 1:246 E JANATA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5377
Practice Address - Country:US
Practice Address - Phone:331-300-1440
Practice Address - Fax:949-655-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1184053415Medicaid