Provider Demographics
NPI:1679025472
Name:PROGRESS FOUNDATION
Entity Type:Organization
Organization Name:PROGRESS FOUNDATION
Other - Org Name:HARSTAD HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINICAL ADMINISTRATION
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:NAVARRO-SIMEON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-861-0828
Mailing Address - Street 1:368 FELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5144
Mailing Address - Country:US
Mailing Address - Phone:415-861-0828
Mailing Address - Fax:415-861-0257
Practice Address - Street 1:1120 GORDON LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5636
Practice Address - Country:US
Practice Address - Phone:707-255-9028
Practice Address - Fax:707-255-3715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESS FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-27
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496803654251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49GH5Medicaid