Provider Demographics
NPI:1477161644
Name:THRIVE ENRICHMENT CENTER, LLC
Entity Type:Organization
Organization Name:THRIVE ENRICHMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLACHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, LLBSW, QIDP
Authorized Official - Phone:989-737-4840
Mailing Address - Street 1:3258 RINGLE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:MI
Mailing Address - Zip Code:48701-9519
Mailing Address - Country:US
Mailing Address - Phone:989-737-4840
Mailing Address - Fax:989-672-0032
Practice Address - Street 1:3258 RINGLE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:MI
Practice Address - Zip Code:48701-9519
Practice Address - Country:US
Practice Address - Phone:989-737-4840
Practice Address - Fax:989-672-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922507094Medicaid