Provider Demographics
NPI:1346493830
Name:PROGRESS HOUSE
Entity Type:Organization
Organization Name:PROGRESS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASI
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-389-9208
Mailing Address - Street 1:2914 COLD SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4220
Mailing Address - Country:US
Mailing Address - Phone:530-626-9240
Mailing Address - Fax:530-626-8992
Practice Address - Street 1:2914 COLD SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4220
Practice Address - Country:US
Practice Address - Phone:530-389-9208
Practice Address - Fax:530-389-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility