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NPI Code Detail

MEDICARE: PROGRESS HOUSE, INC.

MEDICARE: PROGRESS HOUSE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency090002CNCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1090927OTHERCADRUG MEDI-CAL
2090002CNOTHERCADHCS

General Provider Information

NPI Number : 1215072293
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESS HOUSE, INC.
Provider Business Mailing Address
First Line : PO BOX 1666
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-1666
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2844 COLOMA ST
Second Line : PROGRESS HOUSE OUTPATIENT SERVICES
City : PLACERVILLE
State : CA
Zip : 95667-4406
Country : US
Telephone Number : 530-642-1715
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : CINDY CARLSON
Credential :
Telephone Number : 916-317-7230
Provider Enumeration Date : 02/20/2007
Last Update Date : 09/23/2021

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Directions to “PROGRESS HOUSE, INC. ” Practice Location

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