Provider Demographics
NPI:1144419078
Name:PROGRESSIVE HOME WOUND CARE, INC
Entity Type:Organization
Organization Name:PROGRESSIVE HOME WOUND CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:309-737-5286
Mailing Address - Street 1:308 W 6TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9160
Mailing Address - Country:US
Mailing Address - Phone:309-737-5826
Mailing Address - Fax:
Practice Address - Street 1:308 W 6TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9160
Practice Address - Country:US
Practice Address - Phone:309-737-5826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005693251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL357440451001Medicaid
IL246859OtherCORPORATION NUMBER
IL357440451001Medicaid