Provider Demographics
NPI:1093809808
Name:PROGRESSIVE CARE HOME HEALTH
Entity Type:Organization
Organization Name:PROGRESSIVE CARE HOME HEALTH
Other - Org Name:1ST CHOICE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-559-5559
Mailing Address - Street 1:5021 JUSTIN ST
Mailing Address - Street 2:STE. A
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1306
Mailing Address - Country:US
Mailing Address - Phone:936-559-5559
Mailing Address - Fax:936-559-5558
Practice Address - Street 1:5021 JUSTIN ST
Practice Address - Street 2:STE. A
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1306
Practice Address - Country:US
Practice Address - Phone:936-559-5559
Practice Address - Fax:936-559-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009303251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162157502Medicaid
TX679339Medicare ID - Type UnspecifiedPROVIDER NUMBER