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General NPI Number Information
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NPI Number | 1891292991
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Entity Type | Organization
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Legal Business Name | THRIVE TREATMENT CENTER,PLLC
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 841 N BOULDER CT STE B
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City | POST FALLS
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State | ID
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Zip | 83854-8800
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Country | US
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Telephone | 208-916-5938
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Fax | 208-906-8631
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Provider Business Mailing Address
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Address Line | PO BOX 1807
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City | POST FALLS
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State | ID
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Zip | 83877-1807
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Country | US
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Telephone | 208-661-7089
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Fax | 208-906-8631
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | PETER C BROWN
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Credential | ARNP
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Telephone | 208-661-7089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP-1327A
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License Number State | ID
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