Provider Demographics
NPI:1659323012
Name:PROGRESSIVE 2000 HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:PROGRESSIVE 2000 HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:323-655-2011
Mailing Address - Street 1:948 N FAIRFAX AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7204
Mailing Address - Country:US
Mailing Address - Phone:323-655-2011
Mailing Address - Fax:323-655-2057
Practice Address - Street 1:948 N FAIRFAX AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-7204
Practice Address - Country:US
Practice Address - Phone:323-655-2011
Practice Address - Fax:323-655-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70283FOtherMEDI CAL
CA058032Medicare ID - Type Unspecified