Basic Information
| Provider Information | |||||||||
| NPI: | 1790818128 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THRIVE BEHAVIORAL HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KENT CENTER FOR HUMAN & ORGANIZATIONAL DEVELOPMENT, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 CENTERVILLE RD | ||||||||
| Address2: | SUITE 301-S | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028860200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017325656 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1315 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028934807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017325656 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | KUBAS-MEYER | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 4016916000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THRIVE BEHAVIORAL HEALTH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 630.7 | RI | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | KC02233 | 05 | RI | MEDICAID |