Provider Demographics
NPI:1346401114
Name:PROGRESSIVE ROLLING HILLS LLC
Entity Type:Organization
Organization Name:PROGRESSIVE ROLLING HILLS LLC
Other - Org Name:PEARLVIEW - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-661-6800
Mailing Address - Street 1:4426 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2506
Mailing Address - Country:US
Mailing Address - Phone:330-225-9121
Mailing Address - Fax:
Practice Address - Street 1:4426 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2506
Practice Address - Country:US
Practice Address - Phone:330-225-9121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE QUALITY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0339601291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory