MEDICARE: THRIVE CHILDREN'S CENTER 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	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033865118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE CHILDREN'S CENTER LLC

Provider Business Mailing Address
First Line	:	205 SANTILLANE AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2907
Country	:	US
Telephone Number	:	786-614-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 SANTILLANE AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2907
Country	:	US
Telephone Number	:	786-614-2410
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MASSIMO D AMICO
Credential	:	PHD
Telephone Number	:	786-678-4572

Provider Enumeration Date	:	02/26/2022
Last Update Date	:	02/26/2022

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