NPIMap

Organization Active NPI

Thrive Behavioral Network IV, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Alexandria, MN
National Provider Identifier
1740359199
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
1036380 Issued in MN
Legal business name
THRIVE BEHAVIORAL NETWORK IV, LLC
Practice address
909 Broadway
Alexandria, MN 56308-2204
Phone
(320) 763-0124
Fax
(320) 763-0126
NPI assigned
Nov 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1036380 MN Primary

Addresses

Primary practice location

909 Broadway
Alexandria, MN 56308-2204

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
674407900MedicaidMN

Other names 1

  • New Visions 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

909 Broadway St
Alexandria, MN 56308
Phone (320) 763-0124

Practitioners & affiliated clinicians

Practitioners 6

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": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1740359199",
    "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": "909 BROADWAY",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563082204",
            "telephone_number": "320-763-0124",
            "fax_number": "320-763-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE BEHAVIORAL NETWORK IV, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2017-03-30",
        "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": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "1036380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "674407900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Visions Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alexandria, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; 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.