MEDICARE: PROGRESSIVE COMMUNITY CENTER FOR CHILDREN AND FAMILIES INC

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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255032447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE COMMUNITY CENTER FOR CHILDREN AND FAMILIES INC

Provider Business Mailing Address
First Line	:	4219 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3011
Country	:	US
Telephone Number	:	718-715-0400
Fax Number	:	844-384-6174

Provider Business Practice Location Address
First Line	:	4219 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3011
Country	:	US
Telephone Number	:	718-715-0400
Fax Number	:	844-384-6174

Authorized Official
Title or Position	:	CEO
Name	:	FANELL ALERTE
Credential	:
Telephone Number	:	347-693-3518

Provider Enumeration Date	:	03/14/2023
Last Update Date	:	03/14/2023

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