Healthcare Provider Details

I. General information

NPI: 1417112228
Provider Name (Legal Business Name): PROGRESS HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5494 PONY EXPRESS TRAIL
POLLOCK PINES CA
95726-1666
US

IV. Provider business mailing address

PO BOX 1666
PLACERVILLE CA
95667-1666
US

V. Phone/Fax

Practice location:
  • Phone: 530-644-3758
  • Fax: 530-644-3782
Mailing address:
  • Phone: 530-626-9240
  • Fax: 530-644-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JUDY STRAUSS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 530-626-9240