Provider Demographics
NPI:1053286898
Name:THRIVE PPEC LLC
Entity type:Organization
Organization Name:THRIVE PPEC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-246-4138
Mailing Address - Street 1:17 CATALPA CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7500
Mailing Address - Country:US
Mailing Address - Phone:239-686-7732
Mailing Address - Fax:239-686-7732
Practice Address - Street 1:12499 BRANTLEY COMMONS CT STE 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5694
Practice Address - Country:US
Practice Address - Phone:239-686-7732
Practice Address - Fax:239-686-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric