Healthcare Provider Details

I. General information

NPI: 1942688528
Provider Name (Legal Business Name): PROGRESSIVE HOME HEALTH AND HOSPICE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 H STREET
MODESTO CA
95354
US

IV. Provider business mailing address

1320 STANDIFORD AVE STE 4-207
MODESTO CA
95350-0726
US

V. Phone/Fax

Practice location:
  • Phone: 209-505-1035
  • Fax: 209-846-0345
Mailing address:
  • Phone: 209-505-1035
  • Fax: 209-846-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY JEAN THOMPSON
Title or Position: CFO/VP FINANCE AND OPERATIONS
Credential:
Phone: 209-248-7851