NPIMap

Organization Active NPI

Progressive Rehab of PA, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Milford, PA
National Provider Identifier
1750059127
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
PROGRESSIVE REHAB OF PA, INC.
Practice address
112 E Harford St
Milford, PA 18337-1002
Phone
(570) 296-5156
Fax
(570) 296-2592
NPI assigned
Sep 1, 2021
Last updated
Apr 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Mr. Phil R Davis
Title
Vice President
Phone
(404) 233-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

112 E Harford St
Milford, PA 18337-1002

Mailing address

5243 Little Debbie Pkwy Ste 101
Ooltewah, TN 37363-4515
Phone (040) 423-3500

National Provider Directory

National Provider Directory

Locations

112 E Harford St
Milford, PA 18337
Phone (570) 296-5156

5243 Little Debbie Pkwy
Ste 101
Ooltewah, TN 37363

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1750059127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5243 LITTLE DEBBIE PKWY STE 101",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373634515",
            "telephone_number": "040-423-3500",
            "fax_number": "404-233-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E HARFORD ST",
            "city": "MILFORD",
            "state": "PA",
            "postal_code": "183371002",
            "telephone_number": "570-296-5156",
            "fax_number": "570-296-2592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE REHAB OF PA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "PHIL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "404-233-6500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.