1457714875 NPI number — PROGRESSIVE LIFE HOMEMAKER & COMPANION, INC

Table of content: (NPI 1457714875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457714875 NPI number — PROGRESSIVE LIFE HOMEMAKER & COMPANION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE LIFE HOMEMAKER & COMPANION, INC
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 LIFE SERVICES
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:
1457714875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10300 SW 72ND ST STE 447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-975-5108
Provider Business Mailing Address Fax Number:
305-960-7414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10300 SW 72ND ST STE 447
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-975-5108
Provider Business Practice Location Address Fax Number:
305-960-7414
Provider Enumeration Date:
04/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CAZOLA GUTIERREZ
Authorized Official First Name:
LOURDES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-975-5108

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 21526 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21526 . This is a "STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REGISTRATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 30212076 . This is a "NURSE REGISTRY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com