1154872158 NPI number — PROGRESSIVE HOME HEALTH AND HOSPICE CARE, LLC

Table of content: (NPI 1154872158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154872158 NPI number — PROGRESSIVE HOME HEALTH AND HOSPICE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE HOME HEALTH AND HOSPICE CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROGRESSIVE HOSPICE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154872158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1619 H STREET
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95354-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
500-600-3009
Provider Business Mailing Address Fax Number:
209-422-3776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24301 SOUTHLAND DR
Provider Second Line Business Practice Location Address:
SUITE B8
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94545-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-600-3009
Provider Business Practice Location Address Fax Number:
209-422-3776
Provider Enumeration Date:
10/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
CFO/VP FINANCE
Authorized Official Telephone Number:
209-248-7851

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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