Provider Demographics
NPI:1972923563
Name:PROGRESSIVE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PROGRESSIVE HOME HEALTH CARE LLC
Other - Org Name:BD&K ADULT FOSTER CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-850-4400
Mailing Address - Street 1:1028 RIVER FOREST PT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2600
Mailing Address - Country:US
Mailing Address - Phone:678-338-1461
Mailing Address - Fax:770-236-8833
Practice Address - Street 1:1028 RIVER FOREST PT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2600
Practice Address - Country:US
Practice Address - Phone:313-850-4400
Practice Address - Fax:770-236-8833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BD&K ADULT FOSTER CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1689987455251E00000X
GA374U00000X251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care