Provider Demographics
NPI:1497916274
Name:PROGRESSIVE PINES LLC
Entity Type:Organization
Organization Name:PROGRESSIVE PINES LLC
Other - Org Name:GLENDORA - 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 1:1552 N HONEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9511
Mailing Address - Country:US
Mailing Address - Phone:330-264-0912
Mailing Address - Fax:
Practice Address - Street 1:1552 N HONEYTOWN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9511
Practice Address - Country:US
Practice Address - Phone:330-264-0912
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
OH36D0667271291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory