Provider Demographics
NPI:1043045982
Name:PROJECT THRIVE
Entity type:Organization
Organization Name:PROJECT THRIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-368-9771
Mailing Address - Street 1:4747 LINCOLN MALL DR STE 600
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3817
Mailing Address - Country:US
Mailing Address - Phone:708-368-9771
Mailing Address - Fax:773-901-3764
Practice Address - Street 1:4747 LINCOLN MALL DR STE 600
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3817
Practice Address - Country:US
Practice Address - Phone:708-368-9771
Practice Address - Fax:773-901-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health