Provider Demographics
NPI: | 1275955270 |
---|---|
Name: | THRIVE BEHAVIORAL NETWORK II, LLC |
Entity Type: | Organization |
Organization Name: | THRIVE BEHAVIORAL NETWORK II, LLC |
Other - Org Name: | BIRCH TREE CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BRADLEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 612-385-7857 |
Mailing Address - Street 1: | 2700 1ST ST N STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT CLOUD |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 56303-4587 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 320-255-9530 |
Mailing Address - Fax: | 320-251-2996 |
Practice Address - Street 1: | 4720 BURNING TREE RD |
Practice Address - Street 2: | |
Practice Address - City: | DULUTH |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55811-3801 |
Practice Address - Country: | US |
Practice Address - Phone: | 218-623-1800 |
Practice Address - Fax: | 218-623-1811 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-01-09 |
Last Update Date: | 2022-11-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities |