Provider Demographics
NPI:1639792849
Name:THE PROGRESS HOUSE ASSOCIATION
Entity Type:Organization
Organization Name:THE PROGRESS HOUSE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-376-8512
Mailing Address - Street 1:PO BOX 5373
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0373
Mailing Address - Country:US
Mailing Address - Phone:404-376-8512
Mailing Address - Fax:
Practice Address - Street 1:4420 E PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4666
Practice Address - Country:US
Practice Address - Phone:253-472-3552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable