Provider Demographics
NPI:1295761468
Name:PROGRESSIVE HOME HEALTH CARE INC
Entity type:Organization
Organization Name:PROGRESSIVE HOME HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-691-5050
Mailing Address - Street 1:3500 N ROCK RD
Mailing Address - Street 2:BUILDING 400
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1331
Mailing Address - Country:US
Mailing Address - Phone:316-691-5050
Mailing Address - Fax:316-691-5304
Practice Address - Street 1:3500 N ROCK RD
Practice Address - Street 2:BUILDING 400
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1331
Practice Address - Country:US
Practice Address - Phone:316-691-5050
Practice Address - Fax:316-691-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA087051251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100069320DMedicaid
KS100069320DMedicaid