Provider Demographics
NPI:1972021558
Name:THRIVE ADOLESCENT RECOVERY, LLC
Entity Type:Organization
Organization Name:THRIVE ADOLESCENT RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIEKE
Authorized Official - Middle Name:PURCELL
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC008000
Authorized Official - Phone:912-433-7829
Mailing Address - Street 1:127 ABERCORN ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-4069
Mailing Address - Country:US
Mailing Address - Phone:912-433-7829
Mailing Address - Fax:
Practice Address - Street 1:127 ABERCORN ST STE 403
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-4069
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008000101YP2500X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty