Provider Demographics
NPI:1093581837
Name:PROGRESSIVE HOMECARE SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GETAWERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-773-8480
Mailing Address - Street 1:18585 N FALCON LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3756
Mailing Address - Country:US
Mailing Address - Phone:480-773-8480
Mailing Address - Fax:
Practice Address - Street 1:45720 W TUCKER RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-6642
Practice Address - Country:US
Practice Address - Phone:480-773-8480
Practice Address - Fax:480-546-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities