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NPI Code Detail

MEDICARE: DONMACAN INC/DBA PROGRESS HOUSE

MEDICARE: DONMACAN INC/DBA PROGRESS HOUSE
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
1251C00000XDevelopmentally Disabled Services Day Training Agency

Other Identifiers

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

General Provider Information

NPI Number : 1689326134
Entity Type Code : Organization
Provider Name (Legal Business Name) : DONMACAN INC/DBA PROGRESS HOUSE
Provider Business Mailing Address
First Line : 1097 SANDY LN NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4622
Country : US
Telephone Number : 321-298-4652
Fax Number :
Provider Business Practice Location Address
First Line : 1097 SANDY LN NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4622
Country : US
Telephone Number : 321-298-4652
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : SWABY FLYNN
Credential :
Telephone Number : 321-298-4652
Provider Enumeration Date : 01/25/2022
Last Update Date : 01/25/2022

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Directions to “DONMACAN INC/DBA PROGRESS HOUSE ” Practice Location

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