Provider Demographics
NPI:1619092087
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 1:11 N CENTRAL AVE STE 7
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4212
Practice Address - Country:US
Practice Address - Phone:804-675-4550
Practice Address - Fax:434-227-5703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE SKILLED PEDIATRIC CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA497431163WP0200X
163WP0200X, 251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015177800012Medicaid
VA30015177800005Medicaid