Healthcare Provider Details

I. General information

NPI: 1659389021
Provider Name (Legal Business Name): THRIVE WELLNESS AND RECOVERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/30/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W MAIN ST
WATERTOWN NY
13601-1337
US

IV. Provider business mailing address

482 BLACK RIVER PKWY
WATERTOWN NY
13601-2416
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-1530
  • Fax: 315-788-3794
Mailing address:
  • Phone: 315-788-1530
  • Fax: 315-788-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number070310744
License Number StateNY

VIII. Authorized Official

Name: JORDAN JONES
Title or Position: CFO
Credential:
Phone: 315-782-1777