Provider Demographics
NPI:1306024641
Name:THE PEDIATRIC CONNECTION, INC.
Entity Type:Organization
Organization Name:THE PEDIATRIC CONNECTION, INC.
Other - Org Name:THRIVE SKILLED PEDIATRIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-486-4100
Mailing Address - Street 1:101 EDGEWATER DRIVE, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1262
Mailing Address - Country:US
Mailing Address - Phone:781-486-4100
Mailing Address - Fax:
Practice Address - Street 1:100 GATEWAY CENTRE PARKWAY, SUITE 108
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5174
Practice Address - Country:US
Practice Address - Phone:804-200-6250
Practice Address - Fax:855-602-1010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE SKILLED PEDIATRIC CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WP0200X, 251J00000X, 385H00000X
VA0206009101385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015177800001Medicaid