=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790577054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVEBRIGHT COMMUNITY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2507 PARK AVENUE LLD
-----------------------------------------------------
City | SOUTH PLAINFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07866-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-202-0735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 ENTERPRISE DR STE 301
-----------------------------------------------------
City | ROCKAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07866-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-202-0735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SUAD MOHAMMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-202-0735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------