MEDICARE: PROGRESSIVE PARK, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0131N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000225529	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144223462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PARK, LLC

Provider Business Mailing Address
First Line	:	797 E MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-2440
Country	:	US
Telephone Number	:	216-661-6800
Fax Number	:	216-739-3789

Provider Business Practice Location Address
First Line	:	797 E MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-2440
Country	:	US
Telephone Number	:	216-661-6800
Fax Number	:	216-739-3789

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. DANIEL SHILLER
Credential	:
Telephone Number	:	216-661-6800

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/20/2008

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