1174023436 NPI number — THRIVE MENTAL WELLNESS, LLC

Table of content: (NPI 1174023436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174023436 NPI number — THRIVE MENTAL WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIVE MENTAL WELLNESS, 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:
1174023436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19147-7729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-960-8986
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-960-8986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
OZTURK
Authorized Official First Name:
HANNAH
Authorized Official Middle Name:
DOLINGER
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
215-960-8986

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW134374 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SW134374 . This is a "LICENSED SOCIAL WORKER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CW020757 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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