MEDICARE: PROGRESSIVE ROLLING HILLS, 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	1382N	OH

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
2	000000284325	OTHER	OH	ANTHEM BC/BS

General Provider Information

NPI Number	:	1396748612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE ROLLING HILLS, LLC

Provider Business Mailing Address
First Line	:	1632 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2109
Country	:	US
Telephone Number	:	608-448-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4426 HOMESTEAD DR
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-2506
Country	:	US
Telephone Number	:	216-661-6800
Fax Number	:	216-739-3789

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. ISAAK MARKOVITS
Credential	:
Telephone Number	:	608-448-6200

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/14/2025

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