MEDICARE: THRIVE PEDIATRIC NURSING INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number
1	251E00000X	Home Health Agency	AR5369
2	251J00000X	Nursing Care Agency
3	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AR5480	OTHER	AR	CLASS A AND B DERIVITIVE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	AR5648	OTHER	AR	CLASS B (NEW)
5	AR5369	OTHER	AR	ARKANSAS HOME HEALTH CLASS B

General Provider Information

NPI Number	:	1174030860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PEDIATRIC NURSING INC

Provider Business Mailing Address
First Line	:	7197 SHERIDAN RD STE 105
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3261
Country	:	US
Telephone Number	:	870-247-6131
Fax Number	:

Provider Business Practice Location Address
First Line	:	7197 SHERIDAN RD STE 105
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3261
Country	:	US
Telephone Number	:	870-247-6131
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHELLE M MANTUANO
Credential	:
Telephone Number	:	870-247-6131

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	08/21/2023

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