Provider Demographics
NPI:1912521295
Name:THRIVE PEDIATRIC NURSING INC
Entity Type:Organization
Organization Name:THRIVE PEDIATRIC NURSING INC
Other - Org Name:THRIVE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANTUANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-247-6131
Mailing Address - Street 1:11121 N RODNEY PARHAM RD STE 21B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11121 N RODNEY PARHAM RD STE 21B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4158
Practice Address - Country:US
Practice Address - Phone:501-353-1422
Practice Address - Fax:888-901-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR235534514Medicaid
1174030860OtherNPI
AR224683738Medicaid