=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669475968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE MORNING CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2594 E HIGH AVE
-----------------------------------------------------
City | NEW PHILADELPHIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44663-6737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-661-6800
-----------------------------------------------------
Fax | 216-739-3789
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2594 E HIGH AVE
-----------------------------------------------------
City | NEW PHILADELPHIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44663-6737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-661-6800
-----------------------------------------------------
Fax | 216-739-3789
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF FINANCE
-----------------------------------------------------
Name | MR. ISAAK MARKOVITS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-448-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 6107
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------