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General NPI Number Information
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NPI Number | 1912640129
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Entity Type | Organization
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Legal Business Name | THRIVE LGBT
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 568 EAST 101 TH ST, STE4
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City | CLEVELAND
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State | OH
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Zip | 44108
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Country | US
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Telephone | 866-226-1031
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Fax |
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Provider Business Mailing Address
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Address Line | 568 EAST 101 TH ST, STE4
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City | CLEVELAND
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State | OH
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Zip | 44108
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Country | US
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Telephone | 866-226-1031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DRESEAN MATTHEWS
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Credential |
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Telephone | 866-226-1031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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