Provider Demographics
NPI:1326093253
Name:PROGRESSIVE HOME CARE SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:K
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-928-7000
Mailing Address - Street 1:32290 FIVE MILE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-6109
Mailing Address - Country:US
Mailing Address - Phone:313-928-7000
Mailing Address - Fax:313-928-0400
Practice Address - Street 1:32290 FIVE MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-6109
Practice Address - Country:US
Practice Address - Phone:313-928-7000
Practice Address - Fax:313-928-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7563Medicare ID - Type Unspecified