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NPI Code Detail

MEDICARE: THRIVE WELLNESS AND RECOVERY, INC

MEDICARE: THRIVE WELLNESS AND RECOVERY, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone Clinic
2324500000XSubstance Abuse Rehabilitation FacilityNY
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center070310744NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659389021
Entity Type Code : Organization
Provider Name (Legal Business Name) : THRIVE WELLNESS AND RECOVERY, INC
Provider Business Mailing Address
First Line : 482 BLACK RIVER PKWY
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2416
Country : US
Telephone Number : 315-788-1530
Fax Number : 315-788-3794
Provider Business Practice Location Address
First Line : 611 W MAIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-1337
Country : US
Telephone Number : 315-788-1530
Fax Number : 315-788-3794
Authorized Official
Title or Position : CFO
Name : JORDAN JONES
Credential :
Telephone Number : 315-782-1777
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/30/2024

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