Provider Demographics
NPI:1659965705
Name:THRIVE REAL LIFE INDEPENDENCE, LLC
Entity Type:Organization
Organization Name:THRIVE REAL LIFE INDEPENDENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICHICHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-261-3530
Mailing Address - Street 1:108 PATRIOT DR STE A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 PATRIOT DR STE A
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8803
Practice Address - Country:US
Practice Address - Phone:302-261-3530
Practice Address - Fax:302-376-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250571615Medicaid
DE250571618Medicaid
DE250571616Medicaid