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General NPI Number Information
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NPI Number | 1366658098
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE HOME CARE FORT WORTH INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4425 IDA WAY
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City | FORT WORTH
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State | TX
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Zip | 76119-4065
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Country | US
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Telephone | 817-534-9100
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Fax | 210-543-2989
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Provider Business Mailing Address
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Address Line | 244 COUNTY ROAD 2757
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City | MICO
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State | TX
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Zip | 78056-5469
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Country | US
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Telephone | 210-543-9081
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Fax | 210-543-2989
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Authorized Official
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Title or Position | ALTERNATE ADMINISTRATOR
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Name | MR. DARREN H. BROWN
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Credential |
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Telephone | 210-543-9081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011221
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License Number State | TX
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