NPIMap

Organization Active NPI

Thrive Behavioral Network III, LLC

Doing business as Willow Haven

  • Mental Illness Community Based Residential Treatment Facility
  • Lake Elmo, MN
National Provider Identifier
1184840639
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
810111-3-RMI Issued in MN
Legal business name
THRIVE BEHAVIORAL NETWORK III, LLC
Doing business as
Willow Haven
Practice address
3819 Lavern Ave N
Lake Elmo, MN 55042-9629
Phone
(651) 770-2224
Fax
(651) 773-6501
NPI assigned
Apr 17, 2007
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Jeff Bradley
Title
President
Phone
(612) 385-7857

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 810111-3-RMI MN Primary

Addresses

Primary practice location

3819 Lavern Ave N
Lake Elmo, MN 55042-9629

Mailing address

2700 1St St N Ste 300
Saint Cloud, MN 56303-4587
Phone (320) 255-9530

Other names 1

  • Willow Haven Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Thrive Behavioral Network III LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1184840639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 1ST ST N STE 300",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034587",
            "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": "3819 LAVERN AVE N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550429629",
            "telephone_number": "651-770-2224",
            "fax_number": "651-773-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE BEHAVIORAL NETWORK III, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-385-7857"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MN",
            "license": "810111-3-RMI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Haven",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Elmo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.