Healthcare Provider Details

I. General information

NPI: 1639792849
Provider Name (Legal Business Name): THE PROGRESS HOUSE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 E PORTLAND AVE
TACOMA WA
98404-4666
US

IV. Provider business mailing address

PO BOX 5373
TACOMA WA
98415-0373
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-3552
  • Fax:
Mailing address:
  • Phone: 404-376-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: CYNTHA FEDRICK
Title or Position: COO
Credential:
Phone: 404-376-8512