Healthcare Provider Details

I. General information

NPI: 1659323012
Provider Name (Legal Business Name): PROGRESSIVE 2000 HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 N FAIRFAX AVE SUITE 200
LOS ANGELES CA
90046-7204
US

IV. Provider business mailing address

948 N FAIRFAX AVE SUITE 200
LOS ANGELES CA
90046-7204
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-2011
  • Fax: 323-655-2057
Mailing address:
  • Phone: 323-655-2011
  • Fax: 323-655-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. INNA SHUKHMAN
Title or Position: ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 323-655-2011