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General NPI Number Information
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NPI Number | 1174117824
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE LYNDHURST LLC
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 5442 RAE RD
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City | LYNDHURST
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State | OH
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Zip | 44124-1342
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Country | US
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Telephone | 440-684-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 5553 BROADVIEW RD
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City | PARMA
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State | OH
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Zip | 44134-1604
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Country | US
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Telephone | 216-661-6800
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Fax | 440-551-2881
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Authorized Official
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Title or Position | CFO
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Name | MR. DAN SHILLER
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Credential | CPA
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Telephone | 440-684-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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