MEDICARE: PROGRESS HOUSE, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1407322076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESS HOUSE, INC.

Provider Business Mailing Address
First Line	:	201 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3943
Country	:	US
Telephone Number	:	317-637-9816
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3943
Country	:	US
Telephone Number	:	317-637-9816
Fax Number	:	317-692-9149

Authorized Official
Title or Position	:	COO AND GENERAL COUNSEL
Name	:	JOHN DELANEY
Credential	:	JD
Telephone Number	:	317-258-2050

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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Directions to “PROGRESS HOUSE, INC. ” Practice Location

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