Provider Demographics
NPI:1659089001
Name:THRIVE TREATMENT LLC
Entity Type:Organization
Organization Name:THRIVE TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KETCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-975-8474
Mailing Address - Street 1:3101 OCEAN PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3054
Mailing Address - Country:US
Mailing Address - Phone:888-975-8474
Mailing Address - Fax:
Practice Address - Street 1:10837 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3618
Practice Address - Country:US
Practice Address - Phone:888-975-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE TREATMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder