1104091669 NPI number — THRIVE BEHAVIORAL HEALTH, INC.

Table of content: (NPI 1104091669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104091669 NPI number — THRIVE BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIVE BEHAVIORAL HEALTH, INC.
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:
THRIVE BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1104091669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2756 POST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-691-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2756 POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-691-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KUBAS MEYER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
401-691-0000

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 650 . This is a "LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 650.04 . This is a "STATE LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 650.05 . This is a "STATE OF RI LICENSES" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9001843 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650.3 . This is a "STATE LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 650.06 . This is a "STATE LICENSES" identifier . This identifiers is of the category "OTHER".