Provider Demographics
NPI:1679037618
Name:PROGRESSIVE CARE ASSOCIATION
Entity Type:Organization
Organization Name:PROGRESSIVE CARE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:T
Authorized Official - Last Name:MACKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-271-4864
Mailing Address - Street 1:46 W MAPLEWOOD MALL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2810
Mailing Address - Country:US
Mailing Address - Phone:267-271-4864
Mailing Address - Fax:
Practice Address - Street 1:46 W MAPLEWOOD MALL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2810
Practice Address - Country:US
Practice Address - Phone:267-271-4864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered MealsGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care