Healthcare Provider Details

I. General information

NPI: 1912521295
Provider Name (Legal Business Name): THRIVE PEDIATRIC NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11121 N RODNEY PARHAM RD STE 21B
LITTLE ROCK AR
72212-4158
US

IV. Provider business mailing address

11121 N RODNEY PARHAM RD STE 21B
LITTLE ROCK AR
72212-4158
US

V. Phone/Fax

Practice location:
  • Phone: 501-353-1422
  • Fax: 870-247-6130
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE M MANTUANO
Title or Position: PRESIDENT
Credential:
Phone: 870-247-6131