Provider Demographics
NPI:1033650320
Name:PROGRESSIVE MACEDONIA LLC
Entity Type:Organization
Organization Name:PROGRESSIVE MACEDONIA LLC
Other - Org Name:AVENUE AT MACEDONIA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-684-9220
Mailing Address - Street 1:5553 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1604
Mailing Address - Country:US
Mailing Address - Phone:216-661-6800
Mailing Address - Fax:216-739-3789
Practice Address - Street 1:9730 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2040
Practice Address - Country:US
Practice Address - Phone:216-661-6800
Practice Address - Fax:216-739-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility