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General NPI Number Information
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NPI Number | 1013396076
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Entity Type | Organization
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Legal Business Name | THRIVE TREATMENT LLC
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Dates
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Enumeration Date | 05/23/2015
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 3101 OCEAN PARK BLVD #309
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City | SANTA MONICA
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State | CA
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Zip | 90405-3022
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Country | US
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Telephone | 424-230-4682
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25091
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City | WEST LOS ANGELES
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State | CA
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Zip | 90025-0091
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CLAYTON ALAN KETCHUM
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Credential |
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Telephone | 424-230-4682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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