Progressive Health Care Providers/Fern Park, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

4022095 Issued in FL

Legal business name

PROGRESSIVE HEALTH CARE PROVIDERS/FERN PARK, LLC

Doing business as

Fern Park Developmental Center

Practice address

230 Fern Park Blvd
Fern Park, FL 32730-2500

Phone

(407) 331-7231

Fax

(407) 331-9251

NPI assigned

Jul 14, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Terry Revell

Title

Administrator

Phone

(407) 331-7231

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fern Park Developmental Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447259254. Details of each certification follow.

• CCN 10G052 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 10G052

Legal name

FERN PARK DEVELOPMENTAL CENTER

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 21, 1983

Last certification

May 7, 2025

Beds

64

Ownership / control type

Private (non-profit)

Facility address

230 Fern Park Blvd
Fern Park, FL 32730

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447259254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 FERN PARK BLVD",
            "city": "FERN PARK",
            "state": "FL",
            "postal_code": "327302500",
            "telephone_number": "407-331-7231",
            "fax_number": "407-331-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 FERN PARK BLVD",
            "city": "FERN PARK",
            "state": "FL",
            "postal_code": "327302500",
            "telephone_number": "407-331-7231",
            "fax_number": "407-331-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE HEALTH CARE PROVIDERS/FERN PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REVELL",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-331-7231",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "4022095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICF/DD LICENSE",
            "identifier": "4022095",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fern Park Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer N Pearson, LCSW
• Phillips Salomon & Parrish PA
• Rafael R Pinero
• Olivia Kristin Pitkethly, LMHC
• Shari Pridgen, BCBA
• Steve C Randall
• Cavalina Redorrio
• Robert M Reid, D.D.S.
• Aquil Remtullah, RPH
• Anielka Rafaela Rodriguez, M.D.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Fern Park, FL
• Providers in Fern Park, FL by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.