Provider Demographics
NPI:1891292991
Name:THRIVE TREATMENT CENTER,PLLC
Entity type:Organization
Organization Name:THRIVE TREATMENT CENTER,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:208-661-7089
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1807
Mailing Address - Country:US
Mailing Address - Phone:208-661-7089
Mailing Address - Fax:208-906-8631
Practice Address - Street 1:841 N BOULDER CT STE B
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8800
Practice Address - Country:US
Practice Address - Phone:208-916-5938
Practice Address - Fax:208-906-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1327A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty