Provider Demographics
NPI:1851909493
Name:THRIVE THERAPY OF KS LLC
Entity Type:Organization
Organization Name:THRIVE THERAPY OF KS LLC
Other - Org Name:THRIVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:316-771-7315
Mailing Address - Street 1:1005 S GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3203
Mailing Address - Country:US
Mailing Address - Phone:316-771-7315
Mailing Address - Fax:316-771-7319
Practice Address - Street 1:624 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2026
Practice Address - Country:US
Practice Address - Phone:316-771-7315
Practice Address - Fax:316-771-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA087166OtherKANSAS STATE LICENSE