Provider Demographics
NPI:1750059127
Name:PROGRESSIVE REHAB OF PA, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE REHAB OF PA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-233-6500
Mailing Address - Street 1:5243 LITTLE DEBBIE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4515
Mailing Address - Country:US
Mailing Address - Phone:040-423-3500
Mailing Address - Fax:404-233-9021
Practice Address - Street 1:112 E HARFORD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1002
Practice Address - Country:US
Practice Address - Phone:570-296-5156
Practice Address - Fax:570-296-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities