Healthcare Provider Details

I. General information

NPI: 1972923563
Provider Name (Legal Business Name): PROGRESSIVE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 RIVER FOREST PT
LAWRENCEVILLE GA
30045-2600
US

IV. Provider business mailing address

1028 RIVER FOREST PT
LAWRENCEVILLE GA
30045-2600
US

V. Phone/Fax

Practice location:
  • Phone: 313-850-4400
  • Fax: 770-236-8833
Mailing address:
  • Phone: 678-338-1461
  • Fax: 770-236-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1689987455
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number374U00000X
License Number StateGA

VIII. Authorized Official

Name: MS. MARLA MCKENZIE
Title or Position: OWNER
Credential:
Phone: 313-850-4400