Provider Demographics
NPI:1063195808
Name:THRIVE PEDIATRIC NURSING INC
Entity type:Organization
Organization Name:THRIVE PEDIATRIC NURSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANTUANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-247-6131
Mailing Address - Street 1:7197 SHERIDAN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3261
Mailing Address - Country:US
Mailing Address - Phone:870-329-8252
Mailing Address - Fax:888-901-2003
Practice Address - Street 1:254 W MULBERRY AVE STE 3
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6709
Practice Address - Country:US
Practice Address - Phone:501-353-1422
Practice Address - Fax:888-901-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care