Provider Demographics
NPI:1477368942
Name:THRIVE HEALTHCARE CENTER L L C
Entity type:Organization
Organization Name:THRIVE HEALTHCARE CENTER L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:618-838-0176
Mailing Address - Street 1:405 S WHITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2262
Mailing Address - Country:US
Mailing Address - Phone:618-838-0176
Mailing Address - Fax:
Practice Address - Street 1:405 S WHITTLE AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2262
Practice Address - Country:US
Practice Address - Phone:618-838-0176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty