Provider Demographics
NPI:1689326134
Name:DONMACAN INC/DBA PROGRESS HOUSE
Entity Type:Organization
Organization Name:DONMACAN INC/DBA PROGRESS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SWABY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-298-4652
Mailing Address - Street 1:1097 SANDY LN NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4622
Mailing Address - Country:US
Mailing Address - Phone:321-298-4652
Mailing Address - Fax:
Practice Address - Street 1:1097 SANDY LN NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4622
Practice Address - Country:US
Practice Address - Phone:321-298-4652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687287596Medicaid