NPIMap

Organization Active NPI

Thrive Behavioral Network IV, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fergus Falls, MN
National Provider Identifier
1013497916
Registry record updated Aug 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
1093571 Issued in MN
Legal business name
THRIVE BEHAVIORAL NETWORK IV, LLC
Practice address
119 Friberg Ave, Suite B
Fergus Falls, MN 56537-2251
Phone
(218) 531-1528
Fax
(218) 531-1586
NPI assigned
Aug 20, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey John Bradley
Title
President
Phone
(612) 385-7857

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1093571 MN Primary

Addresses

Primary practice location

119 Friberg Ave, Suite B
Fergus Falls, MN 56537-2251

Mailing address

107 Doctors Park
Saint Cloud, MN 56303-1207
Phone (320) 255-9530

Other names 1

  • Transformative Recovery Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
New Visions Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

119 Friberg Ave
Ste B
Fergus Falls, MN 56537
Phone (218) 531-1528

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534723200000",
    "number": "1013497916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 DOCTORS PARK",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031207",
            "telephone_number": "320-255-9530",
            "fax_number": "320-251-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 FRIBERG AVE, SUITE B",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372251",
            "telephone_number": "218-531-1528",
            "fax_number": "218-531-1586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE BEHAVIORAL NETWORK IV, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-20",
        "last_updated": "2018-08-20",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-385-7857"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "1093571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Transformative Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.