Healthcare Provider Details

I. General information

NPI: 1750229209
Provider Name (Legal Business Name): THRIVE COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12553 W EXPLORER DR STE 190
BOISE ID
83713-1612
US

IV. Provider business mailing address

16113 ABIGAIL ST
BENNINGTON NE
68007-5183
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-7083
  • Fax:
Mailing address:
  • Phone: 208-949-7079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: STACEY M WARNER
Title or Position: CEO
Credential:
Phone: 208-949-7079