MEDICARE: PROGRESSIVE GREEN MEADOWS, 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	2298N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31-1504075.179	OTHER	OH	MEDICAL MUTUAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000299600	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1336142645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE GREEN MEADOWS, LLC

Provider Business Mailing Address
First Line	:	7770 COLUMBUS RD NE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9773
Country	:	US
Telephone Number	:	732-674-0589
Fax Number	:

Provider Business Practice Location Address
First Line	:	7770 COLUMBUS RD NE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9773
Country	:	US
Telephone Number	:	732-674-0589
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. DANIEL SHILLER
Credential	:
Telephone Number	:	440-684-9220

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/15/2025

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