Provider Demographics
NPI:1124874755
Name:PROGRESSIVE RECOVERY
Entity type:Organization
Organization Name:PROGRESSIVE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-868-2429
Mailing Address - Street 1:12161 MERCADO DR # 213
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1147
Mailing Address - Country:US
Mailing Address - Phone:716-868-2429
Mailing Address - Fax:
Practice Address - Street 1:12161 MERCADO DR # 213
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1147
Practice Address - Country:US
Practice Address - Phone:716-868-2429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies