Healthcare Provider Details

I. General information

NPI: 1659232296
Provider Name (Legal Business Name): THRIVERX CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N VINE ST UNIT 100C
NEW LENOX IL
60451-1652
US

IV. Provider business mailing address

168 MONEE RD
PARK FOREST IL
60466-2528
US

V. Phone/Fax

Practice location:
  • Phone: 331-688-9793
  • Fax: 331-204-0743
Mailing address:
  • Phone: 708-654-8999
  • Fax: 708-654-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHANEL SMITH
Title or Position: FAMILY NURSE PRACTIONER
Credential: APRN-FPA, FNP-C
Phone: 708-654-8999