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General NPI Number Information
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NPI Number | 1871650655
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE HOUSING, INC.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7270 S SOUTH SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60649-2718
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Country | US
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Telephone | 773-721-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 W WAR MEMORIAL DR SUITE 103
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City | PEORIA
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State | IL
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Zip | 61614-6754
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Country | US
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Telephone | 309-685-0595
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ROB KEIME
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Credential |
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Telephone | 309-685-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 0047811
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License Number State | IL
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