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NPI Code Detail

MEDICARE: PROGRESSIVE PINES, LLC

MEDICARE: PROGRESSIVE PINES, 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
1314000000XSkilled Nursing Facility6211OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000258286OTHEROHANTHEM
331-1504075.075OTHEROHMEDICAL MUTUAL

General Provider Information

NPI Number : 1710980024
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVE PINES, 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 : 1552 N HONEYTOWN RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-9511
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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Directions to “PROGRESSIVE PINES, LLC ” Practice Location

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