Provider Demographics
NPI:1770561839
Name:PROGRESSIVE REHAB NETWORK LTD
Entity type:Organization
Organization Name:PROGRESSIVE REHAB NETWORK LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-582-8668
Mailing Address - Street 1:28362 JAMES DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-5611
Mailing Address - Country:US
Mailing Address - Phone:586-354-2530
Mailing Address - Fax:586-354-2531
Practice Address - Street 1:25625 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1499
Practice Address - Country:US
Practice Address - Phone:586-582-8668
Practice Address - Fax:586-582-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30641OtherBCBSM PROVIDER NUMBER
MI1770561839Medicare UPIN
MI236685Medicare PIN
MI236685Medicare Oscar/Certification