Basic Information
| Provider Information | |||||||||
| NPI: | 1346493830 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROGRESS HOUSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2914 COLD SPRINGS RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956674220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306269240 | ||||||||
| FaxNumber: | 5306268992 | ||||||||
| Practice Location | |||||||||
| Address1: | 2914 COLD SPRINGS RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956674220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303899208 | ||||||||
| FaxNumber: | 5303899209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCOLLUM | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CASI | ||||||||
| AuthorizedOfficialTelephone: | 5303899208 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.