Provider Demographics
NPI:1366658098
Name:PROGRESSIVE HOME CARE FORT WORTH INC.
Entity Type:Organization
Organization Name:PROGRESSIVE HOME CARE FORT WORTH INC.
Other - Org Name:PROGRESSIVE HOME CARE FORT WORTH INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-543-9081
Mailing Address - Street 1:244 COUNTY ROAD 2757
Mailing Address - Street 2:
Mailing Address - City:MICO
Mailing Address - State:TX
Mailing Address - Zip Code:78056-5469
Mailing Address - Country:US
Mailing Address - Phone:210-543-9081
Mailing Address - Fax:210-543-2989
Practice Address - Street 1:4425 IDA WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-4065
Practice Address - Country:US
Practice Address - Phone:817-534-9100
Practice Address - Fax:210-543-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011221251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011221OtherHCCSA LICENSE #