Provider Demographics
NPI:1356717805
Name:VILLAGE OF PROGRESS, INC
Entity type:Organization
Organization Name:VILLAGE OF PROGRESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRION
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-732-2126
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-0418
Mailing Address - Country:US
Mailing Address - Phone:815-732-2126
Mailing Address - Fax:815-732-3228
Practice Address - Street 1:710 S 13TH ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-2133
Practice Address - Country:US
Practice Address - Phone:815-732-2126
Practice Address - Fax:815-732-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services