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	License Number State
1	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912521295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PEDIATRIC NURSING INC

Provider Business Mailing Address
First Line	:	11121 N RODNEY PARHAM RD STE 21B
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72212-4158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11121 N RODNEY PARHAM RD STE 21B
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72212-4158
Country	:	US
Telephone Number	:	501-353-1422
Fax Number	:	870-247-6130

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

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	12/05/2025

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