MEDICARE: THRIVE PPEC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3140N1450X	Pediatric Skilled Nursing Facility

General Provider Information

NPI Number	:	1053286898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PPEC LLC

Provider Business Mailing Address
First Line	:	17 CATALPA CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7500
Country	:	US
Telephone Number	:	239-686-7732
Fax Number	:	239-686-7732

Provider Business Practice Location Address
First Line	:	12499 BRANTLEY COMMONS CT STE 201
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5694
Country	:	US
Telephone Number	:	239-686-7732
Fax Number	:	239-686-7732

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TRACY FILLA
Credential	:	RN
Telephone Number	:	239-246-4138

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	10/10/2025

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Directions to “THRIVE PPEC LLC ” Practice Location

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