Provider Demographics
NPI:1316219314
Name:PROGRESSIVE HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PROGRESSIVE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUFUNMILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNMODEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-252-4324
Mailing Address - Street 1:6000 E. EVANS AVE
Mailing Address - Street 2:BLDG. 1 SUITE 401
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222
Mailing Address - Country:US
Mailing Address - Phone:720-252-4324
Mailing Address - Fax:888-863-3084
Practice Address - Street 1:6000 E. EVANS AVE
Practice Address - Street 2:BLDG. 1 SUITE 401
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:720-252-4324
Practice Address - Fax:888-863-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91335817Medicaid