Healthcare Provider Details

I. General information

NPI: 1306471420
Provider Name (Legal Business Name): PROGRESS RANCH TREATMENT SERVICES FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 ROSIN CT STE 240
SACRAMENTO CA
95834-1639
US

IV. Provider business mailing address

PO BOX 1287
DAVIS CA
95617-1287
US

V. Phone/Fax

Practice location:
  • Phone: 530-746-1544
  • Fax:
Mailing address:
  • Phone: 530-753-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOIS WHISTLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 530-753-2566