Provider Demographics
NPI:1629427166
Name:THRIVE COMMUNITY OPTIONS
Entity Type:Organization
Organization Name:THRIVE COMMUNITY OPTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NARDOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFAMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-366-0412
Mailing Address - Street 1:PO BOX 441095
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80044-1095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 S BLACKHAWK ST
Practice Address - Street 2:#130
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1487
Practice Address - Country:US
Practice Address - Phone:720-366-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40156273Medicaid