Healthcare Provider Details

I. General information

NPI: 1962747154
Provider Name (Legal Business Name): PROGRESSIVE INDEPENDENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34W920 DUCHESNE DR
DUNDEE IL
60118-3125
US

IV. Provider business mailing address

34W920 DUCHESNE DR
DUNDEE IL
60118-3125
US

V. Phone/Fax

Practice location:
  • Phone: 224-558-7599
  • Fax:
Mailing address:
  • Phone: 224-558-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH A LOPEZ
Title or Position: OWNER
Credential:
Phone: 847-551-5911