Provider Demographics
NPI:1215913017
Name:THRIVE DEVELOPMENTAL PARTNERS OF ARKANSAS, INC.
Entity type:Organization
Organization Name:THRIVE DEVELOPMENTAL PARTNERS OF ARKANSAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:870-886-7083
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:PORTIA
Mailing Address - State:AR
Mailing Address - Zip Code:72457-0016
Mailing Address - Country:US
Mailing Address - Phone:870-886-7083
Mailing Address - Fax:870-886-2611
Practice Address - Street 1:208 S. LAWRENCE EXT. STREET
Practice Address - Street 2:
Practice Address - City:PORTIA
Practice Address - State:AR
Practice Address - Zip Code:72457-0016
Practice Address - Country:US
Practice Address - Phone:870-886-7083
Practice Address - Fax:870-886-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125981767Medicaid
AR146080778Medicaid
AR114248715Medicaid
AR132375774Medicaid
AR103152724Medicaid
AR132620786Medicaid
AR320255771Medicaid
AR131867782Medicaid
AR121126732Medicaid