Basic Information
| Provider Information | |||||||||
| NPI: | 1417112228 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROGRESS HOUSE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1666 | ||||||||
| Address2: | |||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956671666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306269240 | ||||||||
| FaxNumber: | 5306443782 | ||||||||
| Practice Location | |||||||||
| Address1: | 5494 PONY EXPRESS TRAIL | ||||||||
| Address2: | |||||||||
| City: | POLLOCK PINES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957261666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306443758 | ||||||||
| FaxNumber: | 5306443782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 07/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | STRAUSS | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5306269240 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.