=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972533966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE HOME HEALTH CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 05/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 SKOKIE BLVD SUITE 303
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-753-6800
-----------------------------------------------------
Fax | 847-753-6801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 SKOKIE BLVD SUITE 303
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-753-6800
-----------------------------------------------------
Fax | 847-753-6801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. POLINA BUKHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-753-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1009851
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------