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General NPI Number Information
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NPI Number | 1972923563
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 1028 RIVER FOREST PT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-2600
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Country | US
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Telephone | 313-850-4400
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Fax | 770-236-8833
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Provider Business Mailing Address
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Address Line | 1028 RIVER FOREST PT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-2600
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Country | US
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Telephone | 678-338-1461
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Fax | 770-236-8833
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARLA MCKENZIE
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Credential |
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Telephone | 313-850-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 374U00000X
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1689987455
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License Number State | GA
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