Healthcare Provider Details

I. General information

NPI: 1477161644
Provider Name (Legal Business Name): THRIVE ENRICHMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3258 RINGLE RD
AKRON MI
48701-9519
US

IV. Provider business mailing address

3258 RINGLE RD
AKRON MI
48701-9519
US

V. Phone/Fax

Practice location:
  • Phone: 989-737-4840
  • Fax: 989-672-0032
Mailing address:
  • Phone: 989-737-4840
  • Fax: 989-672-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICHOLE MCLACHLAN
Title or Position: EXECTIVE DIRECTOR
Credential: MPA, LLBSW, QIDP
Phone: 989-737-4840