Basic Information
| Provider Information | |||||||||
| NPI: | 1629491030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE REHAB SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10015 OLD COLUMBIA RD | ||||||||
| Address2: | SUITE B 215 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210461703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103127631 | ||||||||
| FaxNumber: | 4105101779 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 MORGNEC RD | ||||||||
| Address2: | REHAB DEPARTMENT | ||||||||
| City: | CHESTERTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216201046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107781900 | ||||||||
| FaxNumber: | 4435480904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2014 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHENDE | ||||||||
| AuthorizedOfficialFirstName: | HARSH | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4103127631 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.