MEDICARE: PROGRESSIVE INTERCHANGE HEALTHCARE LLC

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
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306167515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE INTERCHANGE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	5553 BROADVIEW RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-1604
Country	:	US
Telephone Number	:	216-661-6800
Fax Number	:	216-739-3789

Provider Business Practice Location Address
First Line	:	4120 INTERCHANGE CORPORATE CENTER RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5631
Country	:	US
Telephone Number	:	216-896-9900
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. DANIEL SHILLER
Credential	:	CPA
Telephone Number	:	440-684-9220

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	05/03/2021

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