Provider Demographics
NPI:1457714875
Name:PROGRESSIVE LIFE HOMEMAKER & COMPANION, INC
Entity Type:Organization
Organization Name:PROGRESSIVE LIFE HOMEMAKER & COMPANION, INC
Other - Org Name:PROGRESSIVE LIFE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZOLA GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-975-5108
Mailing Address - Street 1:10300 SW 72ND ST STE 447
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3021
Mailing Address - Country:US
Mailing Address - Phone:786-975-5108
Mailing Address - Fax:305-960-7414
Practice Address - Street 1:10300 SW 72ND ST STE 447
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3021
Practice Address - Country:US
Practice Address - Phone:786-975-5108
Practice Address - Fax:305-960-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-02
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
FL21526253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21526OtherSTATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REGISTRATION
FL30212076OtherNURSE REGISTRY