Healthcare Provider Details

I. General information

NPI: 1609873215
Provider Name (Legal Business Name): PROGRESSIVE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 S MCLEOD DR
LAS VEGAS NV
89121-4305
US

IV. Provider business mailing address

4015 S MCLEOD DR
LAS VEGAS NV
89121-4305
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-2200
  • Fax: 702-731-0581
Mailing address:
  • Phone: 702-433-2200
  • Fax: 702-731-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number2681HOS-12
License Number StateNV

VIII. Authorized Official

Name: MRS. ROSEMARY THIELE III
Title or Position: CEO
Credential:
Phone: 702-433-2200