| A Thriving Place Llc | |
|
3274 Briggs Blvd Ne Grand Rapids MI 49525-2502 | |
| (734) 686-0571 | |
| Not Available |
| Full Name | A Thriving Place Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3274 Briggs Blvd Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Sierra Ellison (OWNER) |
| Authorized Official Contact | 6169290324 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Thriving Place Llc 3274 Briggs Blvd Ne Grand Rapids MI 49525-2502 Ph: (734) 686-0571 | A Thriving Place Llc 3274 Briggs Blvd Ne Grand Rapids MI 49525-2502 Ph: (734) 686-0571 |
| NPI Number | 1114648995 |
|---|---|
| Provider Enumeration Date | 09/08/2022 |
| Last Update Date | 05/23/2023 |
| Certification Date | 05/23/2023 |
| Medicare PECOS PAC ID | 2264808518 |
|---|---|
| Medicare Enrollment ID | O20221012001154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114648995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sierra K Ellison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356795215 PECOS PAC ID: 7416368162 Enrollment ID: I20201201002158 |
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