Basic Information
| Provider Information | |||||||||
| NPI: | 1386671535 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THRIVE BEHAVIORAL HEALTH, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KENT CENTER FOR HUMAN & ORGANIZATIONAL DEVELOPMENT, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2756 POST RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028863003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016916000 | ||||||||
| FaxNumber: | 4017386442 | ||||||||
| Practice Location | |||||||||
| Address1: | 2756 POST RD & 50 HEALTH LANE | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028863003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017325656 | ||||||||
| FaxNumber: | 4017388634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROTONDO | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM MANAGER/ACCESS SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4017384229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | N | 193200000X MULTI-SPECIALTY GROUP | 251B00000X | 630 | RI | N | Agencies | Case Management | 251S00000X | 630.7 | RI | N | Agencies | Community/Behavioral Health | 251S00000X | 630.8 | RI | N | Agencies | Community/Behavioral Health | 261QM0801X | 630 | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | 630.00 | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QR0405X | 630 | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 172V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Community Health Worker |
ID Information
| ID | Type | State | Issuer | Description | KC02233 | 05 | RI | MEDICAID | KC06929 | 05 | RI | MEDICAID | KC15427 | 05 | RI | MEDICAID | KC57268 | 05 | RI | MEDICAID | 9001843 | 05 | RI | MEDICAID | KC52696 | 05 | RI | MEDICAID |