Provider Demographics
NPI:1649679572
Name:THRIVE MIDSHORE, INC
Entity type:Organization
Organization Name:THRIVE MIDSHORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-404-7413
Mailing Address - Street 1:3666 MUDDY CREEK RD
Mailing Address - Street 2:OASIS FOUNDATION
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-3418
Mailing Address - Country:US
Mailing Address - Phone:443-203-0103
Mailing Address - Fax:443-203-0104
Practice Address - Street 1:239 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MD
Practice Address - Zip Code:21655-2215
Practice Address - Country:US
Practice Address - Phone:443-203-0103
Practice Address - Fax:443-203-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17162261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone